| Edp Of Wisconsin, Sc | |
|
600 Hartbrook Dr Stop 7 Hartland WI 53029-1436 | |
| (262) 367-0680 | |
| Not Available |
| Full Name | Edp Of Wisconsin, Sc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 600 Hartbrook Dr Stop 7, Hartland, Wisconsin |
| Authorized Official Name and Position | Melissa Garibay (CREDENTIALING MANAGER) |
| Authorized Official Contact | 3127368963 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Edp Of Wisconsin, Sc 141 W Jackson Blvd Ste 210 Chicago IL 60604-3048 Ph: (312) 937-3619 | Edp Of Wisconsin, Sc 600 Hartbrook Dr Stop 7 Hartland WI 53029-1436 Ph: (262) 367-0680 |
| NPI Number | 1639685779 |
|---|---|
| Provider Enumeration Date | 12/27/2017 |
| Last Update Date | 09/14/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639685779 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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