Organization
THE KIDS DENTIST LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHANE FISHER DDS (OWNER)
(262) 241-0400
Entity
Organization
Contact information
Practice address
10618 N PORT WASHINGTON RD, MEQUON, WI 53092-5013
(262) 241-0400
Mailing address
10618 N PORT WASHINGTON RD, MEQUON, WI 53092-5013
(262) 241-0400
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
5127-015
WI
Other
Enumeration date
09/12/2014
Last updated
09/12/2014
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