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Organization

EDP OF WISCONSIN, PC

Active
Parent organization
EDP OF WISCONSIN, PC
Other names
The Centre For Exceptional Dentistry
Organization subpart
Yes

Provider details

NPI number
Legal business name
EDP OF WISCONSIN, PC
Authorized official
ROSEANNE BRUNENKANT (DIRECTOR OF INTEGRATIONS)
(312) 937-3619
Entity
Organization

Contact information

Practice address
1825 N MARTIN LUTHER KING DR, MILWAUKEE, WI 53212-3673
(414) 372-7374
Mailing address
141 W JACKSON BLVD STE 210, CHICAGO, IL 60604-3048
(312) 937-3619
(312) 234-0493

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary

Other

Enumeration date
07/19/2019
Last updated
09/16/2019
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