| West Allis Dental Care, LLC | |
|
7130 W Greenfield Ave West Allis WI 53214-4708 | |
| (414) 258-2500 | |
| (414) 238-6881 |
| Full Name | West Allis Dental Care, LLC |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 7130 W Greenfield Ave, West Allis, Wisconsin |
| Authorized Official Name and Position | Douglas J Persich (OWNER) |
| Authorized Official Contact | 4142582500 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| West Allis Dental Care, LLC 7130 W Greenfield Ave West Allis WI 53214-4708 Ph: (414) 258-2500 | West Allis Dental Care, LLC 7130 W Greenfield Ave West Allis WI 53214-4708 Ph: (414) 258-2500 |
| NPI Number | 1174604888 |
|---|---|
| Provider Enumeration Date | 10/18/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174604888 | NPI | - | NPPES |
| 38357100 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 5001644 (Wisconsin) | Primary |
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