Provider Demographics
NPI:1417633132
Name:TRUE DENTAL MEDPOINT, LLC
Entity Type:Organization
Organization Name:TRUE DENTAL MEDPOINT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REEM
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHJOUB
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:330-717-0578
Mailing Address - Street 1:613 N 36TH ST UNIT 100
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53208-3816
Mailing Address - Country:US
Mailing Address - Phone:330-717-0578
Mailing Address - Fax:414-454-9812
Practice Address - Street 1:2501 W SILVER SPRING DR STE 3
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53209-4217
Practice Address - Country:US
Practice Address - Phone:414-454-9844
Practice Address - Fax:414-454-9812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental