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Organization

KITTLESON ORTHODONTICS, S.C.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. JOHN CLAYTON KITTLESON D.D.S. (VICE-PRESIDENT)
(262) 241-3141
Entity
Organization

Contact information

Practice address
10521 N PORT WASHINGTON RD, MEQUON, WI 53092-5584
(262) 241-3141
Mailing address
10521 N PORT WASHINGTON RD, MEQUON, WI 53092-5584
(262) 241-3141

Taxonomy

Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
4648-015
WI

Other

Enumeration date
08/06/2010
Last updated
08/06/2010
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