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General NPI Number Information
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NPI Number | 1710895503
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Entity Type | Organization
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Legal Business Name | KW LAKE MILLS LLC
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Dates
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Enumeration Date | 09/01/2026
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Last Update Date | 09/01/2026
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Provider Practice Location Address
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Address Line | 119 W LAKE ST
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City | LAKE MILLS
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State | WI
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Zip | 53551-1514
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Country | US
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Telephone | 920-261-8228
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Fax |
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Provider Business Mailing Address
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Address Line | 1518 DOCTORS CT
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City | WATERTOWN
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State | WI
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Zip | 53094-4102
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Country | US
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Telephone | 920-261-8228
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | KYLE GARRO
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Credential | D.D.S.
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Telephone | 920-420-5611
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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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