Provider Demographics
NPI:1851784599
Name:OAK CREEK DENTAL CARE LLC
Entity Type:Organization
Organization Name:OAK CREEK DENTAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:KOESTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:414-762-9010
Mailing Address - Street 1:132 E DREXEL AVE
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-2123
Mailing Address - Country:US
Mailing Address - Phone:414-762-9010
Mailing Address - Fax:
Practice Address - Street 1:132 E DREXEL AVE
Practice Address - Street 2:
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-2123
Practice Address - Country:US
Practice Address - Phone:414-762-9010
Practice Address - Fax:414-570-5492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2481-15261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental