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General NPI Number Information
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NPI Number | 1851499362
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Entity Type | Organization
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Legal Business Name | MARINELLI & FERENTCHAK, DDS, SC
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1011 N MAYFAIR RD SUITE 303
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City | WAUWATOSA
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State | WI
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Zip | 53226-3431
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Country | US
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Telephone | 414-771-4480
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Fax | 414-771-8862
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Provider Business Mailing Address
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Address Line | 1011 N MAYFAIR RD SUITE 303
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City | WAUWATOSA
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State | WI
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Zip | 53226-3431
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Country | US
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Telephone | 414-771-4480
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Fax | 414-771-8862
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Authorized Official
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Title or Position | PARTNER
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Name | KENNETH PAUL FERENTCHAK
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Credential | DDS
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Telephone | 414-771-4480
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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 | 4039
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License Number State | WI
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