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General NPI Number Information
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NPI Number | 1306900451
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Entity Type | Individual
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Provider Name | DANIELLE NOEL BARSTAD DDS
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Gender | Female
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Dates
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Enumeration Date | 12/21/2006
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Last Update Date | 08/18/2021
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Provider Practice Location Address
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Address Line | 9000 W WISCONSIN AVE DENTAL CLINIC
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City | MILWAUKEE
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State | WI
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Zip | 53226-4874
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Country | US
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Telephone | 414-266-2040
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Fax | 414-266-5677
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Provider Business Mailing Address
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Address Line | 9000 W WISCONSIN AVE MS 958
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City | MILWAUKEE
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State | WI
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Zip | 53226-4874
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Country | US
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Telephone | 414-266-7451
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Fax | 414-266-6238
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 1001212-015
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License Number State | WI
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