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General NPI Number Information
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NPI Number | 1346117579
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Entity Type | Organization
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Legal Business Name | 262 FAMILY DENTAL, S.C.
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Dates
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Enumeration Date | 10/22/2025
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Last Update Date | 10/22/2025
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Provider Practice Location Address
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Address Line | 1672 OLD SCHOOL HOUSE ROAD
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City | OCONOMOWOC
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State | WI
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Zip | 53066
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Country | US
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Telephone | 262-244-5220
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Fax |
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Provider Business Mailing Address
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Address Line | 2713 BURRIES RD
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City | HARTLAND
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State | WI
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Zip | 53029-9352
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Country | US
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Telephone | 219-477-8504
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SAMUEL BEHREND
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Credential |
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Telephone | 219-477-8504
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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