Healthcare Provider Details

I. General information

NPI: 1528293321
Provider Name (Legal Business Name): CHARLES FRANK VENTO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2009
Last Update Date: 05/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 MARSH VIEW DR
MUKWONAGO WI
53149-7700
US

IV. Provider business mailing address

2732 NORTHVIEW RD UNIT 78
WAUKESHA WI
53188-2036
US

V. Phone/Fax

Practice location:
  • Phone: 262-363-4041
  • Fax:
Mailing address:
  • Phone: 414-659-0691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6376-15
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: