Individual
TAM LE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
11711 W BURLEIGH ST, WAUWATOSA, WI 53222-3196
(414) 771-2345
Mailing address
11711 W BURLEIGH ST, WAUWATOSA, WI 53222-3196
(414) 771-2345
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
6001949
WI
Other
Enumeration date
10/04/2024
Last updated
10/08/2025
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