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General NPI Number Information
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NPI Number | 1184263022
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Entity Type | Organization
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Legal Business Name | RED ROSE DENTISTRY
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Dates
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Enumeration Date | 12/23/2019
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Last Update Date | 12/23/2019
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Provider Practice Location Address
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Address Line | 12780 W NORTH AVE STE A
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City | BROOKFIELD
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State | WI
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Zip | 53005-4601
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Country | US
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Telephone | 262-860-1500
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Fax |
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Provider Business Mailing Address
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Address Line | 12780 W NORTH AVE STE A
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City | BROOKFIELD
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State | WI
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Zip | 53005-4601
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | EMILY SUE BAKER
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Credential | DDS
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Telephone | 216-501-1090
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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 |
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License Number State |
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