Provider Demographics
NPI:1679694905
Name:SCHWARTZ, BRYAN (DDS)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:SCHWARTZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 W WISCONSIN AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-3416
Mailing Address - Country:US
Mailing Address - Phone:262-737-4004
Mailing Address - Fax:
Practice Address - Street 1:125 W WISCONSIN AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-3416
Practice Address - Country:US
Practice Address - Phone:262-737-4004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI55131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice