Organization
JANESVILLE ENDODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SOFYA SULIM (OFFICE ADMINISTRATOR)
(414) 520-2228
Entity
Organization
Contact information
Practice address
1616 N RANDALL AVE STE 180, JANESVILLE, WI 53545-1155
(608) 314-9000
(608) 314-3241
Mailing address
1616 N RANDALL AVE STE 180, JANESVILLE, WI 53545-1155
(608) 314-9000
(608) 314-3241
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1001926
STATE LICENSE
WI
01
—
1316415086
NPI NUMBER
WI
Enumeration date
06/02/2020
Last updated
06/02/2020
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