Healthcare Provider Details

I. General information

NPI: 1629798723
Provider Name (Legal Business Name): JOSEPHINE TOKAREV DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 08/30/2022
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 W BLUEMOUND RD
MILWAUKEE WI
53213-4145
US

IV. Provider business mailing address

777 N VAN BUREN ST APT 2313
MILWAUKEE WI
53202-3863
US

V. Phone/Fax

Practice location:
  • Phone: 414-771-5600
  • Fax: 414-475-7386
Mailing address:
  • Phone: 305-903-1626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6000074-15
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: