| Grant Park Dental, S.c. | |
|
1333 College Ave Suite C South Milwaukee WI 53172-1150 | |
| (414) 764-6070 | |
| (414) 764-3035 |
| Full Name | Grant Park Dental, S.c. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1333 College Ave, South Milwaukee, Wisconsin |
| Authorized Official Name and Position | Michael Costello (OWNER) |
| Authorized Official Contact | 4147646070 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Grant Park Dental, S.c. 1333 College Ave Suite C South Milwaukee WI 53172-1150 Ph: (414) 764-6070 | Grant Park Dental, S.c. 1333 College Ave Suite C South Milwaukee WI 53172-1150 Ph: (414) 764-6070 |
| NPI Number | 1578994620 |
|---|---|
| Provider Enumeration Date | 11/27/2013 |
| Last Update Date | 11/27/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578994620 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 2736 (Wisconsin) | Primary |
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