Provider Demographics
NPI:1598181141
Name:BRYAN J SCHWARTZ DDS, SC
Entity Type:Organization
Organization Name:BRYAN J SCHWARTZ DDS, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:JON
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:262-737-4004
Mailing Address - Street 1:125 W WISCONSIN AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-3416
Mailing Address - Country:US
Mailing Address - Phone:262-737-4004
Mailing Address - Fax:
Practice Address - Street 1:125 W WISCONSIN AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-3416
Practice Address - Country:US
Practice Address - Phone:262-737-4004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-06
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5513-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty