Healthcare Provider Details

I. General information

NPI: 1467882811
Provider Name (Legal Business Name): MARQUETTE UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2013
Last Update Date: 11/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 W WISCONSIN AVE
MILWAUKEE WI
53233-2186
US

IV. Provider business mailing address

PO BOX 1881
MILWAUKEE WI
53201-1881
US

V. Phone/Fax

Practice location:
  • Phone: 414-288-7485
  • Fax:
Mailing address:
  • Phone: 414-288-6895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number1137116
License Number StateWI

VIII. Authorized Official

Name: MR. TIMOTHY J CREAMER
Title or Position: DENTIST
Credential: DDS
Phone: 414-288-7485