Organization
WISCONSIN DENTAL GROUP, S.C.
Active
Parent organization
WISCONSIN DENTAL GROUP, S.C.
Other names
ForwardDental Forest Home
Organization subpart
Yes
Provider details
NPI number
Legal business name
WISCONSIN DENTAL GROUP, S.C.
Authorized official
CELIA HAYES (CREDENTIALING COORDINATOR)
(217) 540-2100
Entity
Organization
Contact information
Practice address
5100 W FOREST HOME AVE STE 203, MILWAUKEE, WI 53219-4562
(414) 214-1102
(414) 214-1192
Mailing address
5100 W FOREST HOME AVE STE 203, MILWAUKEE, WI 53219-4562
(414) 214-1102
(414) 214-1192
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
03/14/2022
Last updated
03/14/2022
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