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General NPI Number Information
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NPI Number | 1518266998
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Entity Type | Organization
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Legal Business Name | DENTAL ASSOCIATES LTD OF WISCONSIN
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Dates
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Enumeration Date | 03/24/2011
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Last Update Date | 11/15/2022
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Provider Practice Location Address
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Address Line | 11711 W BURLEIGH ST
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City | WAUWATOSA
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State | WI
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Zip | 53222-3196
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Country | US
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Telephone | 414-778-5274
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Fax | 414-777-3229
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Provider Business Mailing Address
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Address Line | 11711 W BURLEIGH ST
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City | WAUWATOSA
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State | WI
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Zip | 53222-3196
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Country | US
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Telephone | 414-778-5274
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Fax | 414-777-3229
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Authorized Official
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Title or Position | DIRECTOR OF PFS DEPT
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Name | MR. SCOTT BAUER
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Credential |
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Telephone | 414-808-3020
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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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Taxonomy #2
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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 #3
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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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 | 1223P0700X
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Taxonomy Name | Prosthodontics
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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Taxonomy #6
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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 #7
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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