| Mdc West Bend, Llc | |
|
1625 W Paradise Dr West Bend WI 53095-7846 | |
| (262) 338-2992 | |
| Not Available |
| Full Name | Mdc West Bend, Llc |
|---|---|
| Speciality | Dentist |
| Location | 1625 W Paradise Dr, West Bend, Wisconsin |
| Authorized Official Name and Position | Bernard Bolka (MEMBER) |
| Authorized Official Contact | 9205793188 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mdc West Bend, Llc 7 Sheboygan St Fond Du Lac WI 54935-4281 Ph: (920) 579-3188 | Mdc West Bend, Llc 1625 W Paradise Dr West Bend WI 53095-7846 Ph: (262) 338-2992 |
| NPI Number | 1497294722 |
|---|---|
| Provider Enumeration Date | 02/20/2017 |
| Last Update Date | 02/20/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497294722 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 5479015 (Wisconsin) | Primary |
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