Organization
LINCOLN AVE DENTAL GROUP SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEVEN RAYMOND KANUGH DDS (PRESIDENT DENTIST)
(414) 645-0217
Entity
Organization
Contact information
Practice address
2700 W LINCOLN AVE, MILWAUKEE, WI 53215
(414) 645-0217
(414) 645-1502
Mailing address
2700 W LINCOLN AVE, MILWAUKEE, WI 53215
(414) 645-0217
(414) 645-1502
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
3800015
WI
1223G0001X
General Practice Dentistry
Primary
5266015
WI
Other
Enumeration date
09/07/2006
Last updated
08/22/2020
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