Organization
AHP 004 LLC
Active
Other names
Virtue Dental
Organization subpart
No
Provider details
NPI number
Authorized official
KATE MANTAY (DIRECTOR OF OPERATIONS)
(262) 649-4900
Entity
Organization
Contact information
Practice address
W236S7050 BIG BEND DR STE 7, BIG BEND, WI 53103-9497
(262) 662-1111
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
—
1992320196
NPI
—
Enumeration date
01/29/2025
Last updated
01/29/2025
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