Organization
BROOKFIELD FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS THADDEOUS TANG D.D.S. (PRESIDENT)
(262) 821-1000
Entity
Organization
Contact information
Practice address
17185 W NORTH AVE, BROOKFIELD, WI 53005-4428
(262) 821-1000
Mailing address
17185 W NORTH AVE, BROOKFIELD, WI 53005-4428
(262) 821-1000
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3801
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1386867679
NPI
WI
Enumeration date
02/25/2008
Last updated
02/25/2008
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