Organization
MEQUONCTD1 LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MITCHELL WEILAND (ASSISTANT CONTROLLER)
(608) 343-0818
Entity
Organization
Contact information
Practice address
7604 W MEQUON RD, MEQUON, WI 53097-3215
(262) 242-8929
Mailing address
8025 EXCELSIOR DR STE 103, MADISON, WI 53717-2902
(608) 343-0818
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
03/16/2021
Last updated
03/16/2021
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