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N81w15062 Appleton Ave Menomonee Falls WI 53051 | |
| (262) 953-4699 | |
| (262) 522-2828 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | N81w15062 Appleton Ave, Menomonee Falls, Wisconsin |
| Authorized Official Name and Position | Renee Ramirez (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 2629534699 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
210 Nw Barstow St Ste 305 Waukesha WI 53188-3771 Ph: (262) 953-4699 | N81w15062 Appleton Ave Menomonee Falls WI 53051 Ph: (262) 953-4699 |
| NPI Number | 1053814772 |
|---|---|
| Provider Enumeration Date | 03/09/2018 |
| Last Update Date | 08/10/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053814772 | NPI | - | NPPES |
| 38398500 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (Wisconsin) | Primary |
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