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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