Healthcare Provider Details

I. General information

NPI: 1043293053
Provider Name (Legal Business Name): CHRISTOPHER E OKUNSERI DDS, MSC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1081 W. WISCONSIN AVE
MILWAUKEE WI
53233-2331
US

IV. Provider business mailing address

5212 W DONGES LN
BROWN DEER WI
53223-1349
US

V. Phone/Fax

Practice location:
  • Phone: 414-288-0788
  • Fax: 414-288-0678
Mailing address:
  • Phone: 414-355-3996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number38-875
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: