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Organization
ADVANCED DENTAL SPECIALISTS, LLC
Active
Organization
ADVANCED DENTAL SPECIALISTS, LLC
Active
Other names
Advanced Dental Specialists
Organization subpart
No
Provider details
NPI number
Authorized official
PETER YOUNG (VICE PRESIDENT OF OPERATIONS)
(414) 357-2040
Entity
Organization
Contact information
Practice address
9052 N DEERBROOK TRL, MILWAUKEE, WI 53223-2474
(414) 357-2040
Mailing address
9052 N DEERBROOK TRL, MILWAUKEE, WI 53223-2474
(414) 357-2040
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
—
NULL
1223E0200X
Endodontics
—
—
1223P0300X
Periodontics
—
NULL
1223P0300X
Periodontics
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
NULL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
03/11/2008
Last updated
03/31/2010
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