Organization
WEST ENDODONTIC GROUP
Active
Other names
Lakeside Endodontics
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KELLY NICOLE WEST DDS (OWNER)
(262) 377-2668
Entity
Organization
Contact information
Practice address
1245 CHEYENNE AVE, SUITE 104, GRAFTON, WI 53024-9323
(262) 377-2889
(262) 377-2680
Mailing address
1245 CHEYENNE AVE, SUITE 104, GRAFTON, WI 53024-9323
(262) 377-2889
(262) 377-2680
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
6129-15
WI
Other
Enumeration date
11/11/2009
Last updated
11/11/2009
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