Individual ProviderBret WaligoraDentistDental ProvidersPractice Address840 N 87th St, Oral And Maxillofacial Surgery, Milwaukee, WI 53226-3586(414) 805-5781PECOS EnrollmentBased on the most recent information from CMS, provider Bret Waligora is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 4 days ago.Profile DetailsProvider ID1467832782Provider TypeIndividualFull NameWaligora, BretTitleDr.CredentialD.D.S.GenderMaleSole ProprietorNoEnumeration Date6/2/2015Last Updated7/2/2015Contact InformationPractice LocationPractice Address840 N 87th St, Oral And Maxillofacial Surgery, Milwaukee, WI 53226-3586Phone(414) 805-5781Fax(414) 259-9115Mailing LocationMailing Address840 N 87th St, Oral And Maxillofacial Surgery, Milwaukee, WI 53226-3586Phone(414) 805-5781Fax(414) 259-9115Provider TaxonomiesCodeDescriptionLicenseCode1223S0112XPrimaryDescriptionDentistDental ProvidersLicense1001147WisconsinCode122300000XDescriptionDentistDental ProvidersLicense2901021509Michigan