Provider Demographics
NPI:1053689554
Name:DHA ORTHODONTICS WEST LLC
Entity Type:Organization
Organization Name:DHA ORTHODONTICS WEST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5181-015332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies