Healthcare Provider Details

I. General information

NPI: 1285529925
Provider Name (Legal Business Name): DENTINO DENTAL SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2025
Last Update Date: 06/12/2025
Certification Date: 06/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18550 W CAPITOL DR
BROOKFIELD WI
53045-1925
US

IV. Provider business mailing address

W156N5382 BETTE DR
MENOMONEE FALLS WI
53051-0634
US

V. Phone/Fax

Practice location:
  • Phone: 262-577-0277
  • Fax: 262-577-0276
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. FRANCIS CASEY DENTINO
Title or Position: DENTIST
Credential: DDS
Phone: 262-825-6541