Organization
WISCONSIN DENTAL GROUP, S.C.
Active
Parent organization
WISCONSIN DENTAL GROUP, S.C.
Other names
ForwardDental Racine
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
6218 WASHINGTON AVE STE C, RACINE, WI 53406-3916
(262) 886-1300
(262) 886-1837
Mailing address
6218 WASHINGTON AVE STE C, MT PLEASANT, WI 53406-3916
(262) 255-2727
(262) 255-3903
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
—
—
1223P0300X
Periodontics
—
—
Other
Enumeration date
03/06/2007
Last updated
03/14/2022
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