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Organization
BRAD WISOWATY DDS LLC
Active
Organization
BRAD WISOWATY DDS LLC
Active
Other names
Modern Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
BRAD WISOWATY DDS (MEMBER)
(708) 945-5405
Entity
Organization
Contact information
Practice address
1302 VALE PARK RD, VALPARAISO, IN 46383-2722
(219) 462-0780
Mailing address
1302 VALE PARK RD, VALPARAISO, IN 46383-2722
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
05/03/2023
Last updated
05/03/2023
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