| Waukeshactd1 Llc | |
|
1547 E Racine Ave Waukesha WI 53186-6826 | |
| (262) 542-4466 | |
| Not Available |
| Full Name | Waukeshactd1 Llc |
|---|---|
| Speciality | Dentist |
| Location | 1547 E Racine Ave, Waukesha, Wisconsin |
| Authorized Official Name and Position | Mitchell Weiland (ASSISTANT CONTROLLER) |
| Authorized Official Contact | 6083430818 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Waukeshactd1 Llc 8025 Excelsior Dr Madison WI 53717-1900 Ph: (608) 343-0818 | Waukeshactd1 Llc 1547 E Racine Ave Waukesha WI 53186-6826 Ph: (262) 542-4466 |
| NPI Number | 1356932727 |
|---|---|
| Provider Enumeration Date | 01/28/2021 |
| Last Update Date | 01/28/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356932727 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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