Provider Demographics
NPI:1245282367
Name:PERRY W SUKOWATEY DDS LTD
Entity type:Organization
Organization Name:PERRY W SUKOWATEY DDS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:SUKOWATEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:414-258-8444
Mailing Address - Street 1:2600 N MAYFAIR RD
Mailing Address - Street 2:SUITE 450 PERRY W SUKOWATEY DDS
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226
Mailing Address - Country:US
Mailing Address - Phone:414-258-8444
Mailing Address - Fax:414-258-9121
Practice Address - Street 1:2600 N MAYFAIR RD
Practice Address - Street 2:SUITE 450
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226
Practice Address - Country:US
Practice Address - Phone:414-258-8444
Practice Address - Fax:414-258-9121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3056122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty