Individual ProviderDavid J GingrassDentistDental ProvidersPractice Address2323 North Mayfair Rd, Suite 102, Milwaukee, WI 53226-1506(414) 257-1161PECOS EnrollmentBased on the most recent information from CMS, provider David J Gingrass does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1538136106Provider TypeIndividualFull NameGingrass, David JCredentialDDSGenderMaleSole ProprietorNoEnumeration Date3/2/2006Last Updated6/17/2010Contact InformationPractice LocationPractice Address2323 North Mayfair Rd, Suite 102, Milwaukee, WI 53226-1506Phone(414) 257-1161Fax(414) 257-0194Mailing LocationMailing Address2323 North Mayfair Rd, Suite 102, Milwaukee, WI 53226-1506Phone(414) 257-1161Fax(414) 257-0194Provider TaxonomiesCodeDescriptionLicenseCode1223S0112XPrimaryDescriptionDentistDental ProvidersLicenseS001616015WisconsinProvider IdentifiersIDDescriptionIssuerID33540900DescriptionMedicaidIssuerUnlistedWisconsin