Organization
SMILEX DENTAL LLC
Active
Other names
Legacy Dental
Organization subpart
No
Provider details
NPI number
Authorized official
JOON JAE PARK (PRESIDENT/OWNER)
(262) 720-4669
Entity
Organization
Contact information
Practice address
924 W OKLAHOMA AVE, MILWAUKEE, WI 53215-4744
(414) 744-6777
Mailing address
924 W OKLAHOMA AVE, MILWAUKEE, WI 53215-4744
(414) 744-6777
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
12/31/2024
Last updated
12/31/2024
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