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Organization
GRAND AVENUE DENTAL CARE, LLC
Active
Organization
GRAND AVENUE DENTAL CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LEAH NICOLE CLANCY DDS (OWNER)
(708) 738-5438
Entity
Organization
Contact information
Practice address
1163 GRAND AVE, HARTFORD, WI 53027-2458
(262) 673-7826
Mailing address
2505 N 84TH ST, WAUWATOSA, WI 53226-1905
(708) 738-5438
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
01/09/2024
Last updated
01/09/2024
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