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General NPI Number Information
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NPI Number | 1184118416
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Entity Type | Organization
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Legal Business Name | BARRETT D. STRAUB DDS, SC
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Dates
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Enumeration Date | 06/20/2018
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Last Update Date | 06/20/2018
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Provider Practice Location Address
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Address Line | 1349 W GRAND AVE
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City | PORT WASHINGTON
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State | WI
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Zip | 53074-2043
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Country | US
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Telephone | 262-284-5505
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Fax | 262-284-5198
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Provider Business Mailing Address
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Address Line | 1349 W GRAND AVE
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City | PORT WASHINGTON
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State | WI
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Zip | 53074-2043
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Country | US
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Telephone | 262-284-5505
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Fax | 262-284-5198
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | DR. BARRETT D STRAUB
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Credential | DDS
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Telephone | 262-284-5505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 5716
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License Number State | WI
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