Organization
YOUNGQUIST KENNEDY ORTHODONTICS, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT R. YOUNGQUIST D.D.S. (PRESIDENT)
(262) 248-0101
Entity
Organization
Contact information
Practice address
255 HAVENWOOD DR, LAKE GENEVA, WI 53147-1917
(262) 248-0101
(262) 248-2941
Mailing address
255 HAVENWOOD DR, LAKE GENEVA, WI 53147-1917
(262) 248-0101
(262) 248-2941
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
2191B
WI
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
6951-15
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33395900
—
WI
Enumeration date
10/12/2006
Last updated
09/25/2017
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