Healthcare Provider Details

I. General information

NPI: 1295656726
Provider Name (Legal Business Name): SIGNATURE DENTISTRY BROOKFIELD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15375 W BLUEMOUND RD STE 150
BROOKFIELD WI
53005-4008
US

IV. Provider business mailing address

133 E BEECHWOOD DR
MEQUON WI
53092-5971
US

V. Phone/Fax

Practice location:
  • Phone: 414-400-3343
  • Fax:
Mailing address:
  • Phone: 414-400-3343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CAMILLE SIMPER
Title or Position: PARTNER
Credential: MBA
Phone: 414-400-3343