Organization
EAST TOWNE DENTAL ASSOCIATES BELGIUM FAMILY DENTAL SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VALI KIAIE DDS (PRESIDENT)
(262) 285-3408
Entity
Organization
Contact information
Practice address
171 MAIN ST, SUITE 200, BELGIUM, WI 53004
(262) 285-3408
(262) 285-4025
Mailing address
PO BOX 147, BELGIUM, WI 53004
(262) 285-3408
(262) 285-4025
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
5301
WI
122300000X
Dentist
Primary
5304
WI
122300000X
Dentist
5993
WI
Other
Enumeration date
02/02/2007
Last updated
08/22/2020
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