| The Center For Dental Excellence, S.c. | |
|
410 Security Blvd Green Bay WI 54313-9705 | |
| (920) 662-1440 | |
| (920) 662-1443 |
| Full Name | The Center For Dental Excellence, S.c. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 410 Security Blvd, Green Bay, Wisconsin |
| Authorized Official Name and Position | David J. Brusky (PRESIDENT) |
| Authorized Official Contact | 9206621440 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| The Center For Dental Excellence, S.c. 410 Security Blvd Green Bay WI 54313-9705 Ph: (920) 662-1440 | The Center For Dental Excellence, S.c. 410 Security Blvd Green Bay WI 54313-9705 Ph: (920) 662-1440 |
| NPI Number | 1013124056 |
|---|---|
| Provider Enumeration Date | 05/17/2007 |
| Last Update Date | 03/24/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013124056 | NPI | - | NPPES |
| 33797600 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 4498-015 (Wisconsin) | Primary |
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