| Quad Med Dental West Allis | |
|
555 S 108th St West Allis WI 53214-1145 | |
| (414) 566-3725 | |
| (414) 566-3900 |
| Full Name | Quad Med Dental West Allis |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 555 S 108th St, West Allis, Wisconsin |
| Authorized Official Name and Position | Robert L Poulsen (CFO) |
| Authorized Official Contact | 4145668400 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Quad Med Dental West Allis W227n6103 Sussex Rd Sussex WI 53089-3969 Ph: (414) 566-8400 | Quad Med Dental West Allis 555 S 108th St West Allis WI 53214-1145 Ph: (414) 566-3725 |
| NPI Number | 1174089130 |
|---|---|
| Provider Enumeration Date | 02/14/2019 |
| Last Update Date | 07/14/2025 |
| Certification Date | 07/14/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174089130 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | () | Primary |
| 261QM1300X | Clinic/center - Multi-specialty | () | Secondary |
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