MEDICARE: DNT ASSOCIATES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1083086821
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DNT ASSOCIATES INC

Provider Business Mailing Address
First Line	:	2572 S 76TH ST
Second Line	:
City	:	WEST ALLIS
State	:	WI
Zip	:	53219-2476
Country	:	US
Telephone Number	:	414-306-6420
Fax Number	:	877-335-3684

Provider Business Practice Location Address
First Line	:	6521 GREEN BAY RD
Second Line	:
City	:	KENOSHA
State	:	WI
Zip	:	53142-2967
Country	:	US
Telephone Number	:	414-306-6420
Fax Number	:	877-335-3684

Authorized Official
Title or Position	:	OWNER
Name	:	MR. DONOVON LEE
Credential	:
Telephone Number	:	414-306-6420

Provider Enumeration Date	:	10/20/2015
Last Update Date	:	10/20/2015

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