Organization
SANDBERG MODERN DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MATTHEW SANDBERG DMD (OWNER)
(414) 258-8190
Entity
Organization
Contact information
Practice address
6535 W NORTH AVE, WAUWATOSA, WI 53213-2016
(414) 258-8190
Mailing address
6535 W NORTH AVE, WAUWATOSA, WI 53213-2016
(414) 258-8190
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
WI 6664-15
WI
Other
Enumeration date
04/02/2015
Last updated
04/02/2015
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