| Keystone South Milwaukee Llc | |
|
1113 College Ave # B South Milwaukee WI 53172-1142 | |
| (414) 764-0212 | |
| Not Available |
| Full Name | Keystone South Milwaukee Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1113 College Ave # B, South Milwaukee, Wisconsin |
| Authorized Official Name and Position | Tammy Kevin (DIRECTOR OF OPERATIONS) |
| Authorized Official Contact | 2628730510 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Keystone South Milwaukee Llc Po Box 180163 Delafield WI 53018-0163 Ph: (262) 873-0510 | Keystone South Milwaukee Llc 1113 College Ave # B South Milwaukee WI 53172-1142 Ph: (414) 764-0212 |
| NPI Number | 1114512225 |
|---|---|
| Provider Enumeration Date | 03/02/2021 |
| Last Update Date | 03/02/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114512225 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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