Organization
EAST TOWNE DENTAL ASSOCIATED BELGIUM FAMILY DENTAL SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VALI KIAIE DDS (PRESIDENT)
(262) 241-8880
Entity
Organization
Contact information
Practice address
11501 N PROT WASHINGTON RD, MEQUON, WI 53092
(262) 241-8880
(262) 241-5250
Mailing address
11501 N PROT WASHINGTON RD, MEQUON, WI 53092
(262) 241-8880
(262) 241-5250
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
5301
WI
122300000X
Dentist
5304
WI
122300000X
Dentist
Primary
5993
WI
Other
Enumeration date
02/01/2007
Last updated
08/22/2020
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