Organization
JAY L. MACKMAN, DDS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KARIEN BAKKER (COO)
(414) 774-7794
Entity
Organization
Contact information
Practice address
2626 N 76TH ST, WAUWATOSA, WI 53213-1137
(414) 476-9400
Mailing address
2626 N 76TH ST, WAUWATOSA, WI 53213-1137
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
WI
Other
Enumeration date
10/28/2010
Last updated
10/28/2010
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