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Organization
GLENDALE DENTAL LLC
Active
Organization
GLENDALE DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER POTRYKUS DDS (OWNER)
(262) 646-2771
Entity
Organization
Contact information
Practice address
5150 N PORT WASHINGTON RD STE 201, GLENDALE, WI 53217-5400
(414) 964-8850
(414) 964-8918
Mailing address
920 INDIAN SPRING DR, DELAFIELD, WI 53018-2242
(262) 873-0510
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
6886
WI
Other
Enumeration date
05/29/2018
Last updated
05/29/2018
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