| Kim Tran-wertz Dds Ms Llc | |
|
12720 W North Ave Brookfield WI 53005-4637 | |
| (262) 782-2300 | |
| (262) 782-2313 |
| Full Name | Kim Tran-wertz Dds Ms Llc |
|---|---|
| Speciality | Dentist |
| Location | 12720 W North Ave, Brookfield, Wisconsin |
| Authorized Official Name and Position | Kim Tran-wertz (DENTIST) |
| Authorized Official Contact | 2627822300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kim Tran-wertz Dds Ms Llc 12720 W North Ave Brookfield WI 53005-4637 Ph: (262) 782-2300 | Kim Tran-wertz Dds Ms Llc 12720 W North Ave Brookfield WI 53005-4637 Ph: (262) 782-2300 |
| NPI Number | 1801198858 |
|---|---|
| Provider Enumeration Date | 11/24/2010 |
| Last Update Date | 11/24/2010 |
| Medicare PECOS PAC ID | 9234318783 |
|---|---|
| Medicare Enrollment ID | O20110128001103 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801198858 | NPI | - | NPPES |
| 33770200 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0700X | Dentist - Prosthodontics | 4384-015 (Wisconsin) | Primary |
| Provider Name | Kim Tran Wertz |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1710094719 PECOS PAC ID: 0143409698 Enrollment ID: I20110128001107 |
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