Provider Demographics
NPI:1134237241
Name:SMALL WORLD CHILDRENS DENTISTRY SC
Entity type:Organization
Organization Name:SMALL WORLD CHILDRENS DENTISTRY SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:E
Authorized Official - Last Name:ARAUJO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:262-780-9996
Mailing Address - Street 1:17585 W NORTH AVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-4365
Mailing Address - Country:US
Mailing Address - Phone:262-780-9996
Mailing Address - Fax:
Practice Address - Street 1:17585 W NORTH AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-4365
Practice Address - Country:US
Practice Address - Phone:262-780-9996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI45771223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33722300Medicaid
WI4577OtherLIC NUMBER
WI4577OtherLIC NUMBER
BA4111504OtherDEA