Provider Demographics
NPI:1003140070
Name:DCP OF DELAFIELD (MILWAUKEE), LLC
Entity Type:Organization
Organization Name:DCP OF DELAFIELD (MILWAUKEE), LLC
Other - Org Name:DENTALWORKS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-487-4867
Mailing Address - Street 1:17300 DALLAS PARKWAY #1070
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248
Mailing Address - Country:US
Mailing Address - Phone:972-755-0880
Mailing Address - Fax:972-755-0890
Practice Address - Street 1:1300 CAPITOL DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-2535
Practice Address - Country:US
Practice Address - Phone:262-691-4140
Practice Address - Fax:262-691-3359
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTALONE PARTNERS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-24
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6155122300000X
1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty