Organization
SOUTH SIDE GUADALUPE DENTAL CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARIA LETICIA MONJE (CLINIC MANAGER)
(414) 643-8787
Entity
Organization
Contact information
Practice address
1112 S 3RD ST, MILWAUKEE, WI 53204-2413
(414) 643-8787
(414) 643-9725
Mailing address
1112 S 3RD ST, MILWAUKEE, WI 53204-2413
(414) 643-8787
(414) 643-9725
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38371500
—
WI
Enumeration date
05/21/2008
Last updated
05/21/2008
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