Provider Demographics
NPI:1386027548
Name:GENERATIONS FAMILY DENTAL CARE MENOMONEE FALLS, LLC
Entity Type:Organization
Organization Name:GENERATIONS FAMILY DENTAL CARE MENOMONEE FALLS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:A
Authorized Official - Last Name:LA COURT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:414-258-2117
Mailing Address - Street 1:N48 W14170 HAMPTON AVE.
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051
Mailing Address - Country:US
Mailing Address - Phone:262-781-8416
Mailing Address - Fax:262-781-9268
Practice Address - Street 1:N48 W14170 HAMPTON AVE.
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051
Practice Address - Country:US
Practice Address - Phone:262-781-8416
Practice Address - Fax:262-781-9268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty