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Organization
WISCONSIN DENTAL GROUP, S. C.
Active
Organization
WISCONSIN DENTAL GROUP, S. C.
Active
Other names
Forward Dental
Organization subpart
No
Provider details
NPI number
Authorized official
PETER YOUNG (VICE PRESIDENT OF OPERATIONS)
(414) 357-2040
Entity
Organization
Contact information
Practice address
9052 N DEERBROOK TRL, MILWAUKEE, WI 53223-2474
(414) 357-2040
Mailing address
9052 N DEERBROOK TRL, MILWAUKEE, WI 53223-2474
(414) 357-2040
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223E0200X
Endodontics
—
—
1223G0001X
General Practice Dentistry
—
—
1223P0221X
Pediatric Dentistry
—
—
1223P0300X
Periodontics
Primary
—
—
Other
Enumeration date
12/15/2006
Last updated
09/11/2025
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