Organization
NORTHTOWN DENTAL GROUP S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES W MACK (PRESIDENT)
(414) 442-4690
Entity
Organization
Contact information
Practice address
1929 W ATKINSON AVE, MILWAUKEE, WI 53206-2452
(414) 442-4690
Mailing address
1929 W ATKINSON AVE, MILWAUKEE, WI 53206-2452
(414) 442-4690
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
5001475
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
333981000
—
WI
Enumeration date
09/02/2009
Last updated
09/02/2009
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