Organization
D2 DENTAL OF WISCONSIN, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BORIS LABINOV (AGENT)
(708) 613-4542
Entity
Organization
Contact information
Practice address
1838 S 15TH ST, MILWAUKEE, WI 53204-3225
(414) 455-8805
Mailing address
137 N OAK PARK AVE STE 310, OAK PARK, IL 60301-1339
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
10/25/2017
Last updated
11/10/2020
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