Provider Demographics
NPI:1790187417
Name:NAJJAR ORTHODONTICS, SC
Entity Type:Organization
Organization Name:NAJJAR ORTHODONTICS, SC
Other - Org Name:THE ORTHODONTIC CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANAS
Authorized Official - Middle Name:
Authorized Official - Last Name:AL NAJJAR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:414-771-5100
Mailing Address - Street 1:1421 S 108TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53214-4012
Mailing Address - Country:US
Mailing Address - Phone:414-771-5100
Mailing Address - Fax:414-771-2513
Practice Address - Street 1:1421 S 108TH ST
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-4012
Practice Address - Country:US
Practice Address - Phone:414-771-5100
Practice Address - Fax:414-771-2513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1000991151223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty