| Ids | |
|
5021 Washington Rd Kenosha WI 53144-4292 | |
| (262) 654-6770 | |
| Not Available |
| Full Name | Ids |
|---|---|
| Speciality | Dentist - Endodontics |
| Location | 5021 Washington Rd, Kenosha, Wisconsin |
| Authorized Official Name and Position | Vicky Gill (OFFICE MANAGER) |
| Authorized Official Contact | 8472637668 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ids 5021 Washington Rd Kenosha WI 53144-4292 Ph: () - | Ids 5021 Washington Rd Kenosha WI 53144-4292 Ph: (262) 654-6770 |
| NPI Number | 1689213787 |
|---|---|
| Provider Enumeration Date | 01/06/2020 |
| Last Update Date | 01/06/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689213787 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223E0200X | Dentist - Endodontics | (* (Not Available)) | Primary |
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