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General NPI Number Information
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NPI Number | 1699846485
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Entity Type | Organization
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Legal Business Name | CENTER FOR COSMETIC DENTISTRY
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2275 DEMING WAY SUITE 180
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City | MIDDLETON
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State | WI
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Zip | 53562-5527
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Country | US
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Telephone | 608-827-6453
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Fax | 608-824-9927
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Provider Business Mailing Address
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Address Line | 2275 DEMING WAY SUITE 180
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City | MIDDLETON
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State | WI
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Zip | 53562-5527
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Country | US
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Telephone | 608-827-6453
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Fax | 608-824-9927
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Authorized Official
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Title or Position | INSURANCE COORDINATOR
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Name | MRS. JENNIFER K SKRENES
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Credential |
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Telephone | 608-827-6453
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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 | 2887
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License Number State | WI
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