| Braden Dental Center Sc | |
|
101 Broad St Ste 203 Lake Geneva WI 53147 | |
| (262) 248-0120 | |
| (262) 249-0140 |
| Full Name | Braden Dental Center Sc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 101 Broad St, Lake Geneva, Wisconsin |
| Authorized Official Name and Position | Mark Thomas Braden (OWNER OF BRADEN DENTAL CENTER) |
| Authorized Official Contact | 2622480120 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Braden Dental Center Sc 101 Broad St Ste 203 Lake Geneva WI 53147 Ph: (262) 248-0120 | Braden Dental Center Sc 101 Broad St Ste 203 Lake Geneva WI 53147 Ph: (262) 248-0120 |
| NPI Number | 1679793632 |
|---|---|
| Provider Enumeration Date | 05/01/2007 |
| Last Update Date | 09/09/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679793632 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 2499 (Wisconsin) | Primary |
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