NPI 1205364197

Kenosha Dentist LLC

Organisation General Practice Dentistry Kenosha, WI

Practice location

Address: 5455 Sheridan Rd STE 201, Kenosha, WI 53140-3752
Phone: (262) 244-0700

Authorised official

Name: Dominic Kaczynski
Title: Business Manager
Phone: (262) 244-0700

Registered specialties

General Practice Dentistry Primary

Dental Providers Taxonomy 1223G0001X

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Registry record

NPI: 1205364197
Entity type: Organization
NPI issued: 23 May 2017
Record last updated: 23 May 2017

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.