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General NPI Number Information
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NPI Number | 1265556930
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Entity Type | Individual
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Provider Name | MAGDA J CANEVARO D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6032 40TH AVE
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City | KENOSHA
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State | WI
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Zip | 53142-7018
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Country | US
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Telephone | 262-656-0764
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Fax | 262-656-1833
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Provider Business Mailing Address
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Address Line | 5222 W BEHRENDT ST
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City | FRANKLIN
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State | WI
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Zip | 53132-8185
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Country | US
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Telephone | 414-282-4095
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Fax | 414-282-4168
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 5046-015
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License Number State | WI
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