Organization
GRACE DENT P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SAGE CAMPIONE DC (OWNER)
(813) 416-7714
Entity
Organization
Contact information
Practice address
N4W22370 BLUEMOUND RD, WAUKESHA, WI 53186-1683
(262) 970-5610
Mailing address
N4W22370 BLUEMOUND RD, WAUKESHA, WI 53186-1683
(262) 970-5610
Taxonomy
Speciality
Code
Description
License number
State
111NN1001X
Nutrition Chiropractor
Primary
4356-12
WI
Other
Enumeration date
02/08/2011
Last updated
02/08/2011
Update your record
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