Organization
PORTWASHINGTONCTD1 LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MITCHELL T WEILAND (ASSISTANT CONTROLLER)
(608) 343-0818
Entity
Organization
Contact information
Practice address
222 N FRANKLIN ST, PORT WASHINGTON, WI 53074-1903
(262) 235-4525
Mailing address
8025 EXCELSIOR DR, MADISON, WI 53717-1900
(608) 343-0818
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
01/28/2021
Last updated
01/28/2021
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