Individual
ADA Y BAZEMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2555 N MARTIN LUTHER KING DR, MILWAUKEE, WI 53212-2709
(414) 372-8080
(414) 562-8432
Mailing address
2555 N MARTIN LUTHER KING DR, MILWAUKEE, WI 53212-2709
(414) 372-8080
(414) 562-8432
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
10515-016
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000002690
MEDICARE PTAN
WI
Enumeration date
06/27/2014
Last updated
06/27/2014
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