| South Side Guadalupe Dental Clinic Inc | |
|
1112 S 3rd St Milwaukee WI 53204-2413 | |
| (414) 643-8787 | |
| (414) 643-9725 |
| Full Name | South Side Guadalupe Dental Clinic Inc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1112 S 3rd St, Milwaukee, Wisconsin |
| Authorized Official Name and Position | Maria Leticia Monje (CLINIC MANAGER) |
| Authorized Official Contact | 4146438787 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| South Side Guadalupe Dental Clinic Inc 1112 S 3rd St Milwaukee WI 53204-2413 Ph: (414) 643-8787 | South Side Guadalupe Dental Clinic Inc 1112 S 3rd St Milwaukee WI 53204-2413 Ph: (414) 643-8787 |
| NPI Number | 1598922122 |
|---|---|
| Provider Enumeration Date | 05/21/2008 |
| Last Update Date | 05/21/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598922122 | NPI | - | NPPES |
| 38371500 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (Wisconsin) | Primary |
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