Organization
DENTAL 360 KENOSHA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IVANA BUENO (DIRECTOR)
(773) 798-9382
Entity
Organization
Contact information
Practice address
3726 ROOSEVELT RD, KENOSHA, WI 53142-1900
(262) 652-7956
Mailing address
3726 ROOSEVELT RD, KENOSHA, WI 53142-1900
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
10/20/2022
Last updated
10/20/2022
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