| Great Lakes Dental, Llc | |
|
W188n11927 Maple Rd Suite 12 Germantown WI 53022-6328 | |
| (262) 509-5755 | |
| (262) 565-2420 |
| Full Name | Great Lakes Dental, Llc |
|---|---|
| Speciality | Dentist |
| Location | W188n11927 Maple Rd, Germantown, Wisconsin |
| Authorized Official Name and Position | Robert J Grzybowski (OWNER) |
| Authorized Official Contact | 2625095755 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Great Lakes Dental, Llc W188n11927 Maple Rd Suite 12 Germantown WI 53022-6328 Ph: (262) 509-5755 | Great Lakes Dental, Llc W188n11927 Maple Rd Suite 12 Germantown WI 53022-6328 Ph: (262) 509-5755 |
| NPI Number | 1043582869 |
|---|---|
| Provider Enumeration Date | 02/09/2012 |
| Last Update Date | 02/09/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043582869 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 4018 (Wisconsin) | Primary |
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