Provider Demographics
NPI:1619557048
Name:BJORKLUND, LUKE
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:
Last Name:BJORKLUND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 N VEL R PHILLIPS AVE UNIT 619
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53203-2809
Mailing Address - Country:US
Mailing Address - Phone:608-963-6219
Mailing Address - Fax:
Practice Address - Street 1:114 GROVE ST
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:WI
Practice Address - Zip Code:53119-2249
Practice Address - Country:US
Practice Address - Phone:262-594-2223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-09
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1002544-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice