Organization
WISCONSIN DENTAL GROUP, S.C.
Active
Parent organization
WISCONSIN DENTAL GROUP, S.C.
Other names
ForwardDental Glendale
Organization subpart
Yes
Provider details
NPI number
Legal business name
WISCONSIN DENTAL GROUP, S.C.
Authorized official
CELIA HAYES (CREDENTIALING COORDINATOR)
(217) 540-2100
Entity
Organization
Contact information
Practice address
7040 N PORT WASHINGTON RD STE 414, GLENDALE, WI 53217-3885
(920) 212-4641
(920) 954-9080
Mailing address
7040 N PORT WASHINGTON RD STE 414, GLENDALE, WI 53217-3885
(920) 212-4641
(920) 954-9080
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
03/06/2007
Last updated
04/15/2022
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