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3500 W Lisbon Ave Milwaukee WI 53208-1953 | |
| (414) 342-0378 | |
| (414) 342-1008 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 3500 W Lisbon Ave, Milwaukee, Wisconsin |
| Authorized Official Name and Position | Randy Robert Ciepluch (OWNER) |
| Authorized Official Contact | 4143420378 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3500 W Lisbon Ave Milwaukee WI 53208-1953 Ph: () - | 3500 W Lisbon Ave Milwaukee WI 53208-1953 Ph: (414) 342-0378 |
| NPI Number | 1043483357 |
|---|---|
| Provider Enumeration Date | 04/08/2008 |
| Last Update Date | 06/20/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043483357 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 2260-015 (Wisconsin) | Primary |
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