Provider Demographics
NPI:1003849100
Name:DHA ORTHODONTICS WEST LLC
Entity Type:Organization
Organization Name:DHA ORTHODONTICS WEST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIVACY OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:T
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:608-833-6112
Mailing Address - Street 1:7007 OLD SAUK RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717-2307
Mailing Address - Country:US
Mailing Address - Phone:608-833-6112
Mailing Address - Fax:608-661-6437
Practice Address - Street 1:7007 OLD SAUK RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53717-2307
Practice Address - Country:US
Practice Address - Phone:608-833-6112
Practice Address - Fax:608-661-6437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty