Organization
ANTISDEL DENTAL CLINIC, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT JAMES ANTISDEL D.D.S. (PRESIDENT / DENTIST)
12622847111
Entity
Organization
Contact information
Practice address
661 E GREEN BAY AVE, SAUKVILLE, WI 53080-2013
(262) 284-7111
(262) 284-1172
Mailing address
661 E GREEN BAY AVE, SAUKVILLE, WI 53080-2013
(262) 284-7111
(262) 284-1172
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2485-015 / 2486-015
WI
Other
Enumeration date
07/27/2006
Last updated
08/22/2020
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