WAUWATOSA FAMILY DENTAL NPI 1821580572

NPI Information

WAUWATOSA FAMILY DENTAL is a dental clinic center in Wauwatosa, WI. WAUWATOSA FAMILY DENTAL NPI is 1821580572. The provider is registered as an organization entity type.

The provider's business location address is:

11904 W NORTH AVE STE 105
WAUWATOSA, WI
ZIP 53226-062
Phone: (414) 454-0700
Fax: (414) 778-0705

The provider's authorized official is Christopher Potrykus .
The authorized official title is Owner and has the following contact phone number (262) 646-2771.

The CLIA number assigned to this NPI record is 52D0390759 - physician office with a certificate type of Certificate of Accreditation.

The enumeration date for this NPI number is 5/30/2018 and was last updated on 5/30/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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