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General NPI Number Information
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NPI Number | 1881573806
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Entity Type | Organization
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Legal Business Name | WISNOVA LLC
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Dates
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Enumeration Date | 09/02/2025
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 5021 WASHINGTON RD
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City | KENOSHA
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State | WI
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Zip | 53144-4292
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Country | US
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Telephone | 262-632-5455
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Fax |
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Provider Business Mailing Address
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Address Line | 5021 WASHINGTON RD
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City | KENOSHA
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State | WI
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Zip | 53144-4292
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/ENDODONTIST
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Name | CODY NELSON
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Credential | DMD
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Telephone | 412-266-8924
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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