Provider Demographics
NPI:1699846485
Name:CENTER FOR COSMETIC DENTISTRY
Entity Type:Organization
Organization Name:CENTER FOR COSMETIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:K
Authorized Official - Last Name:SKRENES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-827-6453
Mailing Address - Street 1:2275 DEMING WAY
Mailing Address - Street 2:SUITE 180
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-5527
Mailing Address - Country:US
Mailing Address - Phone:608-827-6453
Mailing Address - Fax:608-824-9927
Practice Address - Street 1:2275 DEMING WAY
Practice Address - Street 2:SUITE 180
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-5527
Practice Address - Country:US
Practice Address - Phone:608-827-6453
Practice Address - Fax:608-824-9927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI28871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty