| Comprehensive Dental Services Ltd | |
|
10521 N Port Washington Rd Suite 200 Mequon WI 53092 | |
| (262) 241-2060 | |
| (262) 241-2064 |
| Full Name | Comprehensive Dental Services Ltd |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 10521 N Port Washington Rd, Mequon, Wisconsin |
| Authorized Official Name and Position | Marc Jacobson (VICE PRESIDENT) |
| Authorized Official Contact | 2622412060 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Comprehensive Dental Services Ltd 10521 N Port Washington Rd Suite 200 Mequon WI 53092 Ph: (262) 241-2060 | Comprehensive Dental Services Ltd 10521 N Port Washington Rd Suite 200 Mequon WI 53092 Ph: (262) 241-2060 |
| NPI Number | 1154480002 |
|---|---|
| Provider Enumeration Date | 12/06/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154480002 | NPI | - | NPPES |
| 33412900 | Medicaid | WI | |
| 33378400 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 2475-015 (Wisconsin) | Primary |
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› Verified 8 days ago
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