Organization
THE CENTER FOR DENTAL EXCELLENCE, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID J. BRUSKY D.D.S. (PRESIDENT)
(920) 662-1440
Entity
Organization
Contact information
Practice address
410 SECURITY BLVD, GREEN BAY, WI 54313-9705
(920) 662-1440
(920) 662-1443
Mailing address
410 SECURITY BLVD, GREEN BAY, WI 54313-9705
(920) 662-1440
(920) 662-1443
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4498-015
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33797600
—
WI
Enumeration date
05/17/2007
Last updated
03/24/2009
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