| The Kids Dentist Llc | |
|
10618 N Port Washington Rd Mequon WI 53092-5013 | |
| (262) 241-0400 | |
| Not Available |
| Full Name | The Kids Dentist Llc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 10618 N Port Washington Rd, Mequon, Wisconsin |
| Authorized Official Name and Position | Shane Fisher (OWNER) |
| Authorized Official Contact | 2622410400 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| The Kids Dentist Llc 10618 N Port Washington Rd Mequon WI 53092-5013 Ph: (262) 241-0400 | The Kids Dentist Llc 10618 N Port Washington Rd Mequon WI 53092-5013 Ph: (262) 241-0400 |
| NPI Number | 1407257108 |
|---|---|
| Provider Enumeration Date | 09/12/2014 |
| Last Update Date | 09/12/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407257108 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 5127-015 (Wisconsin) | Primary |
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