| The Gentle Dental Emporium Llc | |
|
533 South Main Street West Bend WI 53095 | |
| (262) 338-8704 | |
| (262) 338-9140 |
| Full Name | The Gentle Dental Emporium Llc |
|---|---|
| Speciality | Dentist |
| Location | 533 South Main Street, West Bend, Wisconsin |
| Authorized Official Name and Position | Kenneth M Bero (DDS DENTIST) |
| Authorized Official Contact | 2623388704 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| The Gentle Dental Emporium Llc 533 South Main Street West Bend WI 53095 Ph: (262) 338-8704 | The Gentle Dental Emporium Llc 533 South Main Street West Bend WI 53095 Ph: (262) 338-8704 |
| NPI Number | 1154477818 |
|---|---|
| Provider Enumeration Date | 01/26/2007 |
| Last Update Date | 07/06/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154477818 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | WI2517K (Wisconsin) | Primary |
| 122300000X | Dentist | WI5624 (Wisconsin) | Secondary |
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