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General NPI Number Information
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NPI Number | 1447390521
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Entity Type | Organization
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Legal Business Name | CHILDREN'S DENTAL CLINIC, S.C.
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 3814 S HOWELL AVE
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City | MILWAUKEE
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State | WI
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Zip | 53207-3841
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Country | US
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Telephone | 414-744-3333
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Fax | 414-744-1155
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Provider Business Mailing Address
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Address Line | 3612 TURNBERRY DR
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City | MEQUON
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State | WI
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Zip | 53092-6307
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Country | US
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Telephone | 414-744-3333
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Fax | 414-744-1155
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BALBIR R BAGGA
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Credential | D.D.S., M.S.
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Telephone | 414-744-3333
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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 | 2545
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 2545
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 4146
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License Number State | WI
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