Provider Demographics
NPI:1124168638
Name:WAUKESHA PEDIATRIC DENTAL CARE SC
Entity type:Organization
Organization Name:WAUKESHA PEDIATRIC DENTAL CARE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSANN
Authorized Official - Middle Name:B
Authorized Official - Last Name:NORWICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:262-542-8402
Mailing Address - Street 1:2727 N GRANDVIEW BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1671
Mailing Address - Country:US
Mailing Address - Phone:262-542-8402
Mailing Address - Fax:262-542-4436
Practice Address - Street 1:2727 N GRANDVIEW BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-1671
Practice Address - Country:US
Practice Address - Phone:262-542-8402
Practice Address - Fax:262-542-4436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty