Healthcare Provider Details

I. General information

NPI: 1447390521
Provider Name (Legal Business Name): CHILDREN'S DENTAL CLINIC, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3814 S HOWELL AVE
MILWAUKEE WI
53207-3841
US

IV. Provider business mailing address

3612 TURNBERRY DR
MEQUON WI
53092-6307
US

V. Phone/Fax

Practice location:
  • Phone: 414-744-3333
  • Fax: 414-744-1155
Mailing address:
  • Phone: 414-744-3333
  • Fax: 414-744-1155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2545
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number2545
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4146
License Number StateWI

VIII. Authorized Official

Name: DR. BALBIR R BAGGA
Title or Position: PRESIDENT
Credential: D.D.S., M.S.
Phone: 414-744-3333