Organization
RIDGEVIEW DENTAL GROUP SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MATTHEW THOMAS PRUHS DDS (OWNER/PARTNER)
(262) 251-5355
Entity
Organization
Contact information
Practice address
W178 N9201 WATER TOWER PLACE, SUITE 100, MENOMONEE FALLS, WI 53051
(262) 251-8704
(262) 251-8341
Mailing address
W178 N9201 WATER TOWER PLACE, SUITE 100, MENOMONEE FALLS, WI 53051
(262) 251-8704
(262) 251-8341
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223G0001X
General Practice Dentistry
0004063
WI
1223G0001X
General Practice Dentistry
Primary
5334015
WI
1223P0221X
Pediatric Dentistry
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Enumeration date
11/01/2006
Last updated
03/11/2020
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