# DAVIES PEDIATRIC DENTISTRY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003908856
- **Authorized official:** DR. KIRSTEN M. DAVIES DDS (OWNER)
- **Authorized official phone:** (262) 547-5813

## Contact information

- **Practice address:** 2117 CORPORATE DRIVE, SUITE 100, WAUKESHA, WI 53189
- **Practice address phone:** (262) 547-5813
- **Practice address fax:** (262) 547-5835
- **Mailing address:** 2117 CORPORATE DRIVE, SUITE 100, WAUKESHA, WI 53189
- **Mailing address phone:** (262) 547-5813
- **Mailing address fax:** (262) 547-5835

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | 4907-015 | WI | Yes |
| 1223P0221X | Pediatric Dentistry | 5000400-015 | WI | — |

## Other

- **Enumeration date:** 09/29/2006
- **Last updated:** 07/05/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 33662900 | — | WI |