Organization
MILWAUKEE DENTAL GROUP SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHAM CHANDOK (OWNER)
(414) 378-7971
Entity
Organization
Contact information
Practice address
5542 W FOND DU LAC AVE, MILWAUKEE, WI 53216-1200
(414) 378-7971
Mailing address
5542 W FOND DU LAC AVE, MILWAUKEE, WI 53216-1200
(414) 378-7971
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3107-15
WI
Other
Enumeration date
09/07/2016
Last updated
09/07/2016
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