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General NPI Number Information
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NPI Number | 1598181141
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Entity Type | Organization
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Legal Business Name | BRYAN J SCHWARTZ DDS, SC
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Dates
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Enumeration Date | 03/06/2014
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Last Update Date | 03/17/2016
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Provider Practice Location Address
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Address Line | 125 W WISCONSIN AVE SUITE 102
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City | PEWAUKEE
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State | WI
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Zip | 53072-3416
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Country | US
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Telephone | 262-737-4004
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Fax |
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Provider Business Mailing Address
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Address Line | 125 W WISCONSIN AVE SUITE 102
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City | PEWAUKEE
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State | WI
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Zip | 53072-3416
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Country | US
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Telephone | 262-737-4004
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRYAN JON SCHWARTZ
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Credential | DDS
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Telephone | 262-737-4004
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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 | 5513-15
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License Number State | WI
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