Organization
KEYSTONE WAUKESHA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAMMY KEVIN (VICE PRESIDENT)
(262) 873-0510
Entity
Organization
Contact information
Practice address
1700 CORAL DR, WAUKESHA, WI 53186-1483
(262) 650-3000
Mailing address
PO BOX 180467, DELAFIELD, WI 53018-0467
(262) 873-0510
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
05/31/2024
Last updated
05/31/2024
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