| Wisconsin Dental Group, S.c. | |
|
1320 Pabst Farms Cir Unit 190 Oconomowoc WI 53066-4877 | |
| (262) 244-0288 | |
| (262) 244-0290 |
| Full Name | Wisconsin Dental Group, S.c. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1320 Pabst Farms Cir Unit 190, Oconomowoc, Wisconsin |
| Authorized Official Name and Position | Celia Hayes (CREDENTIALING COORDINATOR) |
| Authorized Official Contact | 2175402100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wisconsin Dental Group, S.c. 1320 Pabst Farms Cir Unit 190 Oconomowoc WI 53066-4877 Ph: (262) 244-0288 | Wisconsin Dental Group, S.c. 1320 Pabst Farms Cir Unit 190 Oconomowoc WI 53066-4877 Ph: (262) 244-0288 |
| NPI Number | 1013665561 |
|---|---|
| Provider Enumeration Date | 03/14/2022 |
| Last Update Date | 03/14/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013665561 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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