Organization
VISTA FAMILY DENTISTRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VASSILIS K PANAGOPOULOS D.D.S. (DENTIST/PRESIDENT)
(262) 717-9104
Entity
Organization
Contact information
Practice address
20855 WATERTOWN RD, SUITE 120, WAUKESHA, WI 53186-1860
(262) 717-9104
(262) 717-9105
Mailing address
20855 WATERTOWN RD, SUITE 120, WAUKESHA, WI 53186-1860
(262) 717-9104
(262) 717-9105
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6265-15
WI
Other
Enumeration date
05/01/2017
Last updated
05/01/2017
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