Healthcare Provider Details

I. General information

NPI: 1013837012
Provider Name (Legal Business Name): MEQUON DENTAL ARTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10033 N PT WASHINGTON RD STE 150
MEQUON WI
53092-5761
US

IV. Provider business mailing address

10033 N PT WASHINGTON RD STE 150
MEQUON WI
53092-5761
US

V. Phone/Fax

Practice location:
  • Phone: 262-241-5558
  • Fax:
Mailing address:
  • Phone: 262-241-5558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID MICHAEL GLINCHER
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 262-241-5558