Organization
ADVANCED DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TAWFIQ S NADI DDS (PRESIDENT)
(414) 914-7000
Entity
Organization
Contact information
Practice address
6425 W GREENFIELD AVE, WEST ALLIS, WI 53214-4939
(414) 914-7000
(414) 914-8000
Mailing address
6425 W GREENFIELD AVE, WEST ALLIS, WI 53214-4939
(414) 914-7000
(414) 914-8000
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6839-15
WI
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
6839-15
WI
Other
Enumeration date
06/21/2014
Last updated
06/21/2014
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