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Your Family Dentist, LLC

Clinic/Center, Dental in Waukesha, WI. Organization (NPI-2).

NPI number1114282829
StatusActive
Last updated in NPPESJul 9, 2012

Details

NPI
1114282829
Entity type
Organization (NPI-2)
Legal business name
Your Family Dentist, LLC
Organization subpart
No
Enumeration date
Jul 9, 2012
Last updated
Jul 9, 2012

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261QD0000X Clinic/Center, Dental4761-15WIYes

Practice location

411 N Grand Ave
Suite 103
Waukesha, WI 53186-4961

Phone 262-513-5677

Mailing address

411 N Grand Ave
Suite 103
Waukesha, WI 53186-4961

Phone 262-513-5677

Authorized official

James F. Murphy
Partner
2625135677

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