Provider Demographics
NPI:1528600863
Name:BROTKOWSKI ACQUISITIONS LLC
Entity Type:Organization
Organization Name:BROTKOWSKI ACQUISITIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS,MD
Authorized Official - Prefix:
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROTKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-612-3407
Mailing Address - Street 1:3000 WESTHILL DR STE 301
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-3795
Mailing Address - Country:US
Mailing Address - Phone:715-845-4511
Mailing Address - Fax:715-845-1898
Practice Address - Street 1:3000 WESTHILL DR STE 301
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-3795
Practice Address - Country:US
Practice Address - Phone:715-845-4511
Practice Address - Fax:715-845-1898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty