Provider Demographics
NPI:1093869109
Name:GREENDALE DENTAL ASSOCIATES, S.C.
Entity Type:Organization
Organization Name:GREENDALE DENTAL ASSOCIATES, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:414-421-2303
Mailing Address - Street 1:5808 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:GREENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53129-2404
Mailing Address - Country:US
Mailing Address - Phone:414-421-2303
Mailing Address - Fax:414-421-2576
Practice Address - Street 1:220A E COMMERCE CT
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:WI
Practice Address - Zip Code:53121-4371
Practice Address - Country:US
Practice Address - Phone:262-723-3224
Practice Address - Fax:262-723-2954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty