Provider Demographics
NPI:1851499362
Name:MARINELLI & FERENTCHAK, DDS, SC
Entity Type:Organization
Organization Name:MARINELLI & FERENTCHAK, DDS, SC
Other - Org Name:DRS. MARINELLI & FERENTCHAK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:FERENTCHAK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:414-771-4480
Mailing Address - Street 1:1011 N MAYFAIR RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3431
Mailing Address - Country:US
Mailing Address - Phone:414-771-4480
Mailing Address - Fax:414-771-8862
Practice Address - Street 1:1011 N MAYFAIR RD
Practice Address - Street 2:SUITE 303
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-3431
Practice Address - Country:US
Practice Address - Phone:414-771-4480
Practice Address - Fax:414-771-8862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI40391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty