Individual
DOUGLAS PERSICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
7130 W GREENFIELD AVE, WEST ALLIS, WI 53214-4708
(414) 258-2500
(414) 238-6881
Mailing address
7130 W GREENFIELD AVE, WEST ALLIS, WI 53214-4708
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
5001644
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33540100
—
WI
Enumeration date
08/08/2008
Last updated
08/08/2008
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