# ADVANCED DENTAL SPECIALISTS, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Advanced Dental Specialists
- **Organization subpart:** No

## Provider details

- **NPI number:** 1972773588
- **Authorized official:** PETER YOUNG (VICE PRESIDENT OF OPERATIONS)
- **Authorized official phone:** (414) 357-2040

## Contact information

- **Practice address:** 9052 N DEERBROOK TRL, MILWAUKEE, WI 53223-2474
- **Practice address phone:** (414) 357-2040
- **Mailing address:** 9052 N DEERBROOK TRL, MILWAUKEE, WI 53223-2474
- **Mailing address phone:** (414) 357-2040

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223E0200X | Endodontics | — | NULL | — |
| 1223E0200X | Endodontics | — | — | — |
| 1223P0300X | Periodontics | — | NULL | — |
| 1223P0300X | Periodontics | — | — | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 03/11/2008
- **Last updated:** 03/31/2010