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General NPI Number Information
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NPI Number | 1235944190
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Entity Type | Organization
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Legal Business Name | 911 DENTAL GROUP
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Dates
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Enumeration Date | 02/10/2025
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Last Update Date | 02/10/2025
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Provider Practice Location Address
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Address Line | 400 LAKE AVE
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City | RACINE
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State | WI
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Zip | 53403-1020
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Country | US
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Telephone | 262-900-2191
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Fax |
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Provider Business Mailing Address
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Address Line | 810 THORNTON ST SE APT 1104
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City | MINNEAPOLIS
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State | MN
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Zip | 55414-3657
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Country | US
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Telephone | 773-640-1715
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. NANA YAW OWUSU
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Credential | DMD
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Telephone | 262-900-2191
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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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