Provider Demographics
NPI:1114282829
Name:YOUR FAMILY DENTIST, LLC
Entity Type:Organization
Organization Name:YOUR FAMILY DENTIST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:F
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-513-5677
Mailing Address - Street 1:411 N GRAND AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-4961
Mailing Address - Country:US
Mailing Address - Phone:262-513-5677
Mailing Address - Fax:
Practice Address - Street 1:411 N GRAND AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-4961
Practice Address - Country:US
Practice Address - Phone:262-513-5677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4761-15261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental