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COMPLETE FAMILY DENTISTRY ON BROADWAY NPI 1174524425


NPI Information

NPI: 1174524425
Provider Name: COMPLETE FAMILY DENTISTRY ON BROADWAY

Doing Business As: COMPLETE FAMILY DENTISTRY

Classification: Dentist - 1223G0001X
Entity Type: Organization

Specialization: General Practice

Address:
419 E BROADWAY
WAUKESHA, WI
ZIP 53186
Phone: (262) 549-6850
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COMPLETE FAMILY DENTISTRY ON BROADWAY is a general practice dentist in Waukesha, WI. The provider is a general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. COMPLETE FAMILY DENTISTRY ON BROADWAY NPI is 1174524425. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Complete Family Dentistry.

The provider's business location address is:

419 E BROADWAY
WAUKESHA, WI
ZIP 53186-082
Phone: (262) 549-6850
Fax: (262) 549-2157

The provider's authorized official is Karen M Jahimiak .
The authorized official title is Partner and has the following contact phone number (262) 549-6850.

The enumeration date for this NPI number is 8/9/2005 and was last updated on 8/22/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
11223G0001XDentistGeneral Practice3689WISCONSINYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
133495600MEDICAIDWISCONSIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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