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NPI Code Detail

MEDICARE: DOCTORS' DENTURE SYSTEMS SC

MEDICARE: DOCTORS' DENTURE SYSTEMS SC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry2614WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1043403140
Entity Type Code : Organization
Provider Name (Legal Business Name) : DOCTORS' DENTURE SYSTEMS SC
Provider Business Mailing Address
First Line : 501 W LINCOLN AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53207-1133
Country : US
Telephone Number : 414-671-5720
Fax Number : 414-671-5745
Provider Business Practice Location Address
First Line : 501 W LINCOLN AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53207-1133
Country : US
Telephone Number : 414-671-5720
Fax Number : 414-671-5745
Authorized Official
Title or Position : PRESIDENT
Name : DR. MARK J KNEEPKENS
Credential : DDS
Telephone Number : 414-671-5720
Provider Enumeration Date : 08/22/2007
Last Update Date : 06/17/2008

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