| Davies Pediatric Dentistry | |
|
2117 Corporate Drive Suite 100 Waukesha WI 53189 | |
| (262) 547-5813 | |
| (262) 547-5835 |
| Full Name | Davies Pediatric Dentistry |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 2117 Corporate Drive, Waukesha, Wisconsin |
| Authorized Official Name and Position | Kirsten M. Davies (OWNER) |
| Authorized Official Contact | 2625475813 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Davies Pediatric Dentistry 2117 Corporate Drive Suite 100 Waukesha WI 53189 Ph: (262) 547-5813 | Davies Pediatric Dentistry 2117 Corporate Drive Suite 100 Waukesha WI 53189 Ph: (262) 547-5813 |
| NPI Number | 1003908856 |
|---|---|
| Provider Enumeration Date | 09/29/2006 |
| Last Update Date | 07/05/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003908856 | NPI | - | NPPES |
| 33662900 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 4907-015 (Wisconsin) | Primary |
| 1223P0221X | Dentist - Pediatric Dentistry | 5000400-015 (Wisconsin) | Secondary |
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