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General NPI Number Information
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NPI Number | 1851367585
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Entity Type | Individual
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Provider Name | KENNETH DELL DEMBNY II M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/23/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 201 N MAYFAIR RD SUITE 530
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City | WAUWATOSA
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State | WI
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Zip | 53226-4216
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Country | US
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Telephone | 414-443-0033
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Fax | 414-443-0034
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Provider Business Mailing Address
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Address Line | 13405 JUNEAU BLVD
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City | ELM GROVE
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State | WI
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Zip | 53122-1723
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Country | US
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Telephone | 262-797-6176
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 35379020
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License Number State | WI
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