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General NPI Number Information
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NPI Number | 1487429205
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Entity Type | Organization
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Legal Business Name | WD DENTAL IMPLANT
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Dates
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Enumeration Date | 11/21/2023
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Last Update Date | 11/21/2023
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Provider Practice Location Address
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Address Line | 21 S BRUNS AVE
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City | PLYMOUTH
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State | WI
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Zip | 53073-2562
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Country | US
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Telephone | 920-892-2951
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Fax |
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Provider Business Mailing Address
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Address Line | 21 S BRUNS AVE
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City | PLYMOUTH
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State | WI
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Zip | 53073-2562
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Country | US
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Telephone | 920-892-2951
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DENISE SHIH O'BRIEN
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Credential | DDS
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Telephone | 414-520-6806
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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