Individual
KEVIN TANTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
15100 LIBRARY LN, NEW BERLIN, WI 53151-5291
(262) 641-0056
Mailing address
15100 LIBRARY LN, NEW BERLIN, WI 53151-5291
(262) 641-0056
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6434
WI
Other
Enumeration date
07/15/2009
Last updated
07/15/2009
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