| Periodontal & Implant Specialists Of Madison, Llc | |
|
49 N Walbridge Ave. Madison WI 53717 | |
| (608) 833-2578 | |
| (608) 203-7105 |
| Full Name | Periodontal & Implant Specialists Of Madison, Llc |
|---|---|
| Speciality | Dentist |
| Location | 49 N Walbridge Ave., Madison, Wisconsin |
| Authorized Official Name and Position | Jan K Streich (CLINIC ADMINISTRATOR) |
| Authorized Official Contact | 6086616412 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Periodontal & Implant Specialists Of Madison, Llc 2971 Chapel Valley Rd. Fitchburg WI 57311-7240 Ph: (608) 661-6400 | Periodontal & Implant Specialists Of Madison, Llc 49 N Walbridge Ave. Madison WI 53717 Ph: (608) 833-2578 |
| NPI Number | 1366614885 |
|---|---|
| Provider Enumeration Date | 03/25/2008 |
| Last Update Date | 08/27/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366614885 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 3628 (Wisconsin) | Primary |
| 122300000X | Dentist | 6136 (Wisconsin) | Secondary |
| 122300000X | Dentist | 6215 (Wisconsin) | Secondary |
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