Provider Demographics
NPI:1295185981
Name:EMERGENCY DENTAL OF MILWAUKEE, LLC
Entity Type:Organization
Organization Name:EMERGENCY DENTAL OF MILWAUKEE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTEAGUDO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:414-383-5833
Mailing Address - Street 1:1469 S 70TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53214-4814
Mailing Address - Country:US
Mailing Address - Phone:414-383-5833
Mailing Address - Fax:414-383-0233
Practice Address - Street 1:1469 S 70TH ST
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-4814
Practice Address - Country:US
Practice Address - Phone:414-383-5833
Practice Address - Fax:414-383-0233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI41861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty