| 911 Dental Group | |
|
400 Lake Ave Racine WI 53403-1020 | |
| (262) 900-2191 | |
| Not Available |
| Full Name | 911 Dental Group |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 400 Lake Ave, Racine, Wisconsin |
| Authorized Official Name and Position | Nana Yaw Owusu (CEO) |
| Authorized Official Contact | 2629002191 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| 911 Dental Group 810 Thornton St Se Apt 1104 Minneapolis MN 55414-3657 Ph: (773) 640-1715 | 911 Dental Group 400 Lake Ave Racine WI 53403-1020 Ph: (262) 900-2191 |
| NPI Number | 1235944190 |
|---|---|
| Provider Enumeration Date | 02/10/2025 |
| Last Update Date | 02/10/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235944190 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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