Individual
LUCIANA MIRANDA WILTSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS, MS
Contact information
Practice address
12888 W. BLUEMOUND RD., ELM GROVE, WI 53122
(262) 439-8233
(262) 439-8246
Mailing address
12888 W. BLUEMOUND RD., ELM GROVE, WI 53122
(262) 439-8233
(262) 439-8246
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
08191
IA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
6102-15
WI
Other
Enumeration date
09/11/2006
Last updated
04/15/2022
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