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General NPI Number Information
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NPI Number | 1437236536
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Entity Type | Organization
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Legal Business Name | RIDGEVIEW DENTAL GROUP SC
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 03/11/2020
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Provider Practice Location Address
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Address Line | W178 N9201 WATER TOWER PLACE SUITE 100
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City | MENOMONEE FALLS
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State | WI
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Zip | 53051
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Country | US
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Telephone | 262-251-8704
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Fax | 262-251-8341
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Provider Business Mailing Address
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Address Line | W178 N9201 WATER TOWER PLACE SUITE 100
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City | MENOMONEE FALLS
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State | WI
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Zip | 53051
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Country | US
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Telephone | 262-251-8704
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Fax | 262-251-8341
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Authorized Official
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Title or Position | OWNER/PARTNER
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Name | DR. MATTHEW THOMAS PRUHS
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Credential | DDS
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Telephone | 262-251-5355
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0004063
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 5334015
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License Number State | WI
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