Organization
PRO DENTAL WI 1 PC
Active
Other names
Destiny Dental of Milwaukee
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SIMONE WILSON-ADELEKE MPA-PPA (DIRECTOR OF CREDENTIALING)
(732) 731-8398
Entity
Organization
Contact information
Practice address
1838 S 15TH ST, MILWAUKEE, WI 53204-3225
(414) 455-8805
(414) 455-8812
Mailing address
10 WOODBRIDGE CENTER DR STE 520, WOODBRIDGE, NJ 07095-1152
(732) 731-8398
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
1223G0001X
General Practice Dentistry
—
—
Other
Enumeration date
09/18/2024
Last updated
09/18/2024
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