# GRACE DENT P.A.

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

## Provider details

- **NPI number:** 1598061640
- **Authorized official:** DR. SAGE CAMPIONE DC (OWNER)
- **Authorized official phone:** (813) 416-7714

## Contact information

- **Practice address:** N4W22370 BLUEMOUND RD, WAUKESHA, WI 53186-1683
- **Practice address phone:** (262) 970-5610
- **Mailing address:** N4W22370 BLUEMOUND RD, WAUKESHA, WI 53186-1683
- **Mailing address phone:** (262) 970-5610

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111NN1001X | Nutrition Chiropractor | 4356-12 | WI | Yes |

## Other

- **Enumeration date:** 02/08/2011
- **Last updated:** 02/08/2011