| Summit Square Dental Llc | |
|
3228 Turnberry Oak Dr Waukesha WI 53188-3969 | |
| (262) 544-0171 | |
| Not Available |
| Full Name | Summit Square Dental Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 3228 Turnberry Oak Dr, Waukesha, Wisconsin |
| Authorized Official Name and Position | Timothy J Mathison (PRESIDENT & CEO) |
| Authorized Official Contact | 6087098303 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Summit Square Dental Llc 3228 Turnberry Oak Dr Waukesha WI 53188-3969 Ph: (262) 544-0171 | Summit Square Dental Llc 3228 Turnberry Oak Dr Waukesha WI 53188-3969 Ph: (262) 544-0171 |
| NPI Number | 1144764978 |
|---|---|
| Provider Enumeration Date | 12/13/2016 |
| Last Update Date | 12/13/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144764978 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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