Provider Demographics
NPI:1467832782
Name:WALIGORA, BRET (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRET
Middle Name:
Last Name:WALIGORA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 N 87TH ST
Mailing Address - Street 2:ORAL AND MAXILLOFACIAL SURGERY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3586
Mailing Address - Country:US
Mailing Address - Phone:414-805-5781
Mailing Address - Fax:414-259-9115
Practice Address - Street 1:840 N 87TH ST
Practice Address - Street 2:ORAL AND MAXILLOFACIAL SURGERY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3586
Practice Address - Country:US
Practice Address - Phone:414-805-5781
Practice Address - Fax:414-259-9115
Is Sole Proprietor?:No
Enumeration Date:2015-06-02
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901021509122300000X
WI10011471223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist