NPI 1053312389

Family Dental of South East Wisconsin, S.C.

Organisation Dentist West Allis, WI

Practice location

Address: 10202 W Hayes Ave, West Allis, WI 53227-2042
Phone: (414) 321-2720
Fax: (414) 321-7718

Authorised official

Name: Thomas P Casey
Title: Employee
Phone: (414) 321-2720

Registered specialties (3)

Dentist Primary

Dental Providers Taxonomy 122300000X Licence 3499 (WI)

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Dentist

Dental Providers Taxonomy 122300000X Licence 2304 (WI)

Dentist

Dental Providers Taxonomy 122300000X Licence 6783 (WI)

Registry record

NPI: 1053312389
Entity type: Organization
NPI issued: 9 Aug 2005
Record last updated: 23 Oct 2019

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.