Organization
GREAT LAKES DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT J GRZYBOWSKI DDS (OWNER)
(262) 509-5755
Entity
Organization
Contact information
Practice address
W188N11927 MAPLE RD, SUITE 12, GERMANTOWN, WI 53022-6328
(262) 509-5755
(262) 565-2420
Mailing address
W188N11927 MAPLE RD, SUITE 12, GERMANTOWN, WI 53022-6328
(262) 509-5755
(262) 565-2420
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
4018
WI
Other
Enumeration date
02/09/2012
Last updated
02/09/2012
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