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Organization

PRAIRIE ORTHDONTICS S.C.

Active
Parent organization
PRAIRIE ORTHODONTICS
Organization subpart
Yes

Provider details

NPI number
Legal business name
PRAIRIE ORTHODONTICS
Authorized official
DR. MICHAEL G. WEINBERG D.M.D. (ORTHODONTIST)
(262) 637-8800
Entity
Organization

Contact information

Practice address
5024 N GREENBAY RD, SUITE 150, KENOSHA, WI 53144-1714
(262) 637-8800
Mailing address
5024 N GREENBAY RD, SUITE 150, KENOSHA, WI 53144-1714
(262) 637-8800

Taxonomy

Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
6500-15
WI

Other

Enumeration date
07/19/2011
Last updated
08/01/2011
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