Provider Demographics
NPI:1043403140
Name:DOCTORS' DENTURE SYSTEMS SC
Entity Type:Organization
Organization Name:DOCTORS' DENTURE SYSTEMS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:KNEEPKENS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:414-671-5720
Mailing Address - Street 1:501 W LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-1133
Mailing Address - Country:US
Mailing Address - Phone:414-671-5720
Mailing Address - Fax:414-671-5745
Practice Address - Street 1:501 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53207-1133
Practice Address - Country:US
Practice Address - Phone:414-671-5720
Practice Address - Fax:414-671-5745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI26141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38372300Medicaid