Organization
BRAD WISOWATY DDS LLC
Active
Other names
Modern Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
BRAD WISOWATY DDS (MEMBER)
(708) 945-5405
Entity
Organization
Contact information
Practice address
1302 VALE PARK RD, VALPARAISO, IN 46383-2722
(219) 462-0780
Mailing address
1302 VALE PARK RD, VALPARAISO, IN 46383-2722
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
05/03/2023
Last updated
05/03/2023
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