Organization
WISCONSIN CHILDREN'S GENERAL ANESTHESIA DENTISTRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFERY WHEELER (CEO)
(301) 494-3000
Entity
Organization
Contact information
Practice address
7007 N RANGE LINE RD, GLENDALE, WI 53209-2620
(301) 494-3000
Mailing address
1220 CARAWAY CT STE 1050, UPPER MARLBORO, MD 20774-5338
(301) 494-3000
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
07/18/2024
Last updated
09/18/2024
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