| Northside Kenosha Dental | |
|
2600 22nd Ave Kenosha WI 53140-4813 | |
| (262) 658-1410 | |
| Not Available |
| Full Name | Northside Kenosha Dental |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 2600 22nd Ave, Kenosha, Wisconsin |
| Authorized Official Name and Position | Sharon L Loso (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 5635821448 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Northside Kenosha Dental 40 Main St Ste 100 Dubuque IA 52001-7654 Ph: (563) 582-1448 | Northside Kenosha Dental 2600 22nd Ave Kenosha WI 53140-4813 Ph: (262) 658-1410 |
| NPI Number | 1861046047 |
|---|---|
| Provider Enumeration Date | 07/26/2019 |
| Last Update Date | 07/29/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861046047 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Secondary |
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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Gregory A. Santarelli Dds Sc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 5017 Green Bay Rd Ste 138, Kenosha, WI 53144 Phone: 262-654-6770 Fax: 262-654-6727 | |
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