Healthcare Provider Details

I. General information

NPI: 1013937499
Provider Name (Legal Business Name): MARQUETTE UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 11/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 W WISCONSIN AVE SUITE 145 B
MILWAUKEE WI
53233-2186
US

IV. Provider business mailing address

PO BOX 1881 SUITE 145 B
MILWAUKEE WI
53201-1881
US

V. Phone/Fax

Practice location:
  • Phone: 414-288-5902
  • Fax: 414-288-8361
Mailing address:
  • Phone: 414-288-5902
  • Fax: 414-288-8361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MR. TIMOTHY C CREAMER
Title or Position: ASSOCIATE DEAN
Credential: DDS
Phone: 414-288-7485