| Wisconsin Dental Group, S.c. | |
|
6218 Washington Ave Ste C Racine WI 53406-3916 | |
| (262) 886-1300 | |
| (262) 886-1837 |
| Full Name | Wisconsin Dental Group, S.c. |
|---|---|
| Speciality | Dentist - Endodontics |
| Location | 6218 Washington Ave Ste C, Racine, Wisconsin |
| Authorized Official Name and Position | Celia Hayes (CREDENTIALING COORDINATOR) |
| Authorized Official Contact | 2175402100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wisconsin Dental Group, S.c. 6218 Washington Ave Ste C Mt Pleasant WI 53406-3916 Ph: (262) 255-2727 | Wisconsin Dental Group, S.c. 6218 Washington Ave Ste C Racine WI 53406-3916 Ph: (262) 886-1300 |
| NPI Number | 1366572927 |
|---|---|
| Provider Enumeration Date | 03/06/2007 |
| Last Update Date | 03/14/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366572927 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0300X | Dentist - Periodontics | (* (Not Available)) | Secondary |
| 1223E0200X | Dentist - Endodontics | (* (Not Available)) | Primary |
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