# BRAD WISOWATY DDS LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Modern Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1609565910
- **Authorized official:** BRAD WISOWATY DDS (MEMBER)
- **Authorized official phone:** (708) 945-5405

## Contact information

- **Practice address:** 1302 VALE PARK RD, VALPARAISO, IN 46383-2722
- **Practice address phone:** (219) 462-0780
- **Mailing address:** 1302 VALE PARK RD, VALPARAISO, IN 46383-2722

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | — | Yes |

## Other

- **Enumeration date:** 05/03/2023
- **Last updated:** 05/03/2023