# CHILDREN'S DENTAL CARE OF KENOSHA

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

## Provider details

- **NPI number:** 1215948377
- **Authorized official:** DENNIS M CONNOLLY DDS MS (PRESIDENT)
- **Authorized official phone:** (262) 658-3488

## Contact information

- **Practice address:** 2901 35TH ST, KENOSHA, WI 53140-5119
- **Practice address phone:** (262) 658-3488
- **Practice address fax:** (262) 658-3433
- **Mailing address:** 2901 35TH ST, KENOSHA, WI 53140-5119
- **Mailing address phone:** (262) 658-3488
- **Mailing address fax:** (262) 658-3433

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | — | NULL | Yes |
| 1223P0221X | Pediatric Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 08/11/2006
- **Last updated:** 08/22/2020