1386761583 NPI number — ACCOMMODENT DENTAL ASSOC. S.C.

Table of content: (NPI 1386761583)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386761583 NPI number — ACCOMMODENT DENTAL ASSOC. S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACCOMMODENT DENTAL ASSOC. S.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SMILES ON BROADWAY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386761583
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/25/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
735 NORTH WATER STREET
Provider Second Line Business Mailing Address:
SUITE 926
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-272-8866
Provider Business Mailing Address Fax Number:
414-272-8831

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
735 NORTH WATER STREET
Provider Second Line Business Practice Location Address:
SUITE 926
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-272-8866
Provider Business Practice Location Address Fax Number:
414-272-8831
Provider Enumeration Date:
03/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ZEEB
Authorized Official First Name:
PERRY
Authorized Official Middle Name:
G.
Authorized Official Title or Position:
PRESIDENT/DENTIST
Authorized Official Telephone Number:
414-272-8866

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  3676 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com