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NPI Code Detail

MEDICARE: DOUGLAS PERSICH DDS

MEDICARE: DOUGLAS PERSICH DDS
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
1122300000XDentist5001644WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1205082377
Entity Type Code : Individual
Provider Name (Legal Business Name) : DOUGLAS PERSICH DDS
Provider Business Mailing Address
First Line : 7130 W GREENFIELD AVE
Second Line :
City : WEST ALLIS
State : WI
Zip : 53214-4708
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7130 W GREENFIELD AVE
Second Line :
City : WEST ALLIS
State : WI
Zip : 53214-4708
Country : US
Telephone Number : 414-258-2500
Fax Number : 414-238-6881
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2008
Last Update Date : 08/08/2008

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Directions to “ DOUGLAS PERSICH DDS” Practice Location

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