Organization
EDP OF WISCONSIN, SC
Active
Parent organization
ELITE DENTAL PARTNERS
Other names
Drs. Leaman, Setnicar & Piacsek
Organization subpart
Yes
Provider details
NPI number
Legal business name
ELITE DENTAL PARTNERS
Authorized official
ROSEANNE BRUNENKANT (DIRECTOR OF INTEGRATIONS)
(312) 937-3619
Entity
Organization
Contact information
Practice address
820 SUMMIT AVE, OCONOMOWOC, WI 53066-3973
(312) 800-1270
Mailing address
141 W JACKSON BLVD STE 210, CHICAGO, IL 60604-3048
(312) 937-3619
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
04/01/2019
Last updated
09/16/2019
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