Organization
MEQUON DEER DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OLGA GRENOVA (DIR OF ACCOUNTING)
(608) 833-2213
Entity
Organization
Contact information
Practice address
7400 W BROWN DEER RD, MILWAUKEE, WI 53223-2078
(414) 354-1160
Mailing address
8025 EXCELSIOR DR, MADISON, WI 53717-1900
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
06/15/2020
Last updated
06/15/2020
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