Organization
ENDODONTIC SPECIALISTS, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID BELARDI D.D.S. (OWNER)
(414) 546-1900
Entity
Organization
Contact information
Practice address
10401 W LINCOLN AVE, STE. 104, WEST ALLIS, WI 53227-1255
(414) 546-1900
(414) 546-1901
Mailing address
10401 W LINCOLN AVE, STE. 104, WEST ALLIS, WI 53227-1255
(414) 546-1900
(414) 546-1901
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
4387-015
WI
1223E0200X
Endodontics
5520-015
WI
1223E0200X
Endodontics
Primary
5534-015
WI
1223E0200X
Endodontics
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
77631-001
—
WI
Enumeration date
01/22/2007
Last updated
08/22/2020
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