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N80w17707 Custer Ln Menomonee Falls WI 53051-3630 | |
| (262) 502-0605 | |
| (262) 415-1266 |
| Full Name | |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | N80w17707 Custer Ln, Menomonee Falls, Wisconsin |
| Authorized Official Name and Position | Celia Hayes (CREDENTIALING COORDINATOR) |
| Authorized Official Contact | 2175402100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
N80w17707 Custer Ln Menomonee Falls WI 53051-3630 Ph: (262) 502-0605 | N80w17707 Custer Ln Menomonee Falls WI 53051-3630 Ph: (262) 502-0605 |
| NPI Number | 1720118987 |
|---|---|
| Provider Enumeration Date | 03/06/2007 |
| Last Update Date | 03/14/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720118987 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | (* (Not Available)) | Primary |
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