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Organization
LAYTON DENTAL LAB
Active
Organization
LAYTON DENTAL LAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD BONG (PRESIDENT)
(262) 691-7100
Entity
Organization
Contact information
Practice address
495 HICKORY ST, PEWAUKEE, WI 53072-3537
(262) 691-7100
Mailing address
495 HICKORY ST, PEWAUKEE, WI 53072-3537
(262) 691-7100
Taxonomy
Speciality
Code
Description
License number
State
292200000X
Dental Laboratory
Primary
—
NULL
Other
Enumeration date
06/06/2013
Last updated
06/06/2013
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