| NPI | 1861046047 |
|---|---|
| Doing Business As | NORTHSIDE KENOSHA DENTAL |
| Entity Type | Organization |
| Authorized Contact | SHARON L LOSO Credentialing Specialist 563-582-1448 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2019-07-26 |
| Last Update Date | 2019-07-29 |