Organization
AHP 002 LLC
Active
Other names
The Good Dentist
Organization subpart
No
Provider details
NPI number
Authorized official
KATE MANTAY (DIRECTOR OF OPERATIONS)
(262) 649-4900
Entity
Organization
Contact information
Practice address
N67W28025 SUSSEX RD STE 100, HARTLAND, WI 53029-8619
(262) 538-0892
Mailing address
15285 WATERTOWN PLANK RD STE 200, ELM GROVE, WI 53122-2339
(262) 649-4900
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1114779501
NPI
—
01
—
1336668367
NPI
—
01
—
1861847097
NPI
—
Enumeration date
01/29/2025
Last updated
01/29/2025
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