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General NPI Number Information
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NPI Number | 1659654127
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Entity Type | Organization
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Legal Business Name | EON CLINICS
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Dates
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Enumeration Date | 09/21/2011
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Last Update Date | 09/21/2011
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Provider Practice Location Address
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Address Line | 20700 SWENSON DR
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City | WAUKESHA
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State | WI
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Zip | 53186-0900
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Country | US
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Telephone | 262-798-8880
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Fax | 262-798-8881
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Provider Business Mailing Address
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Address Line | 20700 SWENSON DR
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City | WAUKESHA
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State | WI
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Zip | 53186-0900
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Country | US
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Telephone | 262-798-8880
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Fax | 262-798-8881
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RAJAN SHARMA
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Credential | DDS
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Telephone | 262-798-8880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 2678-015
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License Number State | WI
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