| The Downtown Dental Group | |
|
161 W Wisconsin Ave Suite 5036 Milwaukee WI 53203-2602 | |
| (414) 278-6070 | |
| (414) 278-6087 |
| Full Name | The Downtown Dental Group |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 161 W Wisconsin Ave, Milwaukee, Wisconsin |
| Authorized Official Name and Position | Michael L Costello (OWNER) |
| Authorized Official Contact | 4142786070 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| The Downtown Dental Group 161 W Wisconsin Ave Suite 5036 Milwaukee WI 53203-2602 Ph: (414) 278-6070 | The Downtown Dental Group 161 W Wisconsin Ave Suite 5036 Milwaukee WI 53203-2602 Ph: (414) 278-6070 |
| NPI Number | 1902975709 |
|---|---|
| Provider Enumeration Date | 11/07/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902975709 | NPI | - | NPPES |
| 38373000 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 2736 (Wisconsin) | Primary |
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