Organization
WISCONSIN DENTAL GROUP, S. C.
Active
Other names
Forward Dental
Organization subpart
No
Provider details
NPI number
Authorized official
PETER YOUNG (VICE PRESIDENT OF OPERATIONS)
(414) 357-2040
Entity
Organization
Contact information
Practice address
9052 N DEERBROOK TRL, MILWAUKEE, WI 53223-2474
(414) 357-2040
Mailing address
9052 N DEERBROOK TRL, MILWAUKEE, WI 53223-2474
(414) 357-2040
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223E0200X
Endodontics
—
—
1223G0001X
General Practice Dentistry
—
—
1223P0221X
Pediatric Dentistry
—
—
1223P0300X
Periodontics
Primary
—
—
Other
Enumeration date
12/15/2006
Last updated
09/11/2025
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