Organization
CGR DENTAL, SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDWARD STEPANENKOV (PRESIDENT)
(608) 335-2030
Entity
Organization
Contact information
Practice address
4706 COTTAGE GROVE RD, STE. 400, MADISON, WI 53716-1323
(608) 268-1700
Mailing address
4706 COTTAGE GROVE RD, STE. 400, MADISON, WI 53716-1323
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
07/12/2012
Last updated
07/12/2012
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