Organization
MERIDIAN ENDODONTICS AND PERIODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JARED FRISBIE-TEEL (OWNER/DOCTOR)
(262) 327-6100
Entity
Organization
Contact information
Practice address
20350 WATER TOWER BLVD STE 203, BROOKFIELD, WI 53045-3558
(262) 327-6100
Mailing address
20350 WATER TOWER BLVD STE 203, BROOKFIELD, WI 53045-3558
(262) 327-6100
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
6591
WI
1223E0200X
Endodontics
Primary
6841.15
WI
1223P0300X
Periodontics
6852.15
WI
Other
Enumeration date
06/25/2013
Last updated
06/25/2013
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