Provider Demographics
NPI:1851832943
Name:DENTAMED HEALTHCARE LLC
Entity Type:Organization
Organization Name:DENTAMED HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELAYE
Authorized Official - Middle Name:
Authorized Official - Last Name:OKUNSERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-568-4298
Mailing Address - Street 1:3900 W BROWN DEER RD
Mailing Address - Street 2:SUITE A, #212
Mailing Address - City:BROWN DEER
Mailing Address - State:WI
Mailing Address - Zip Code:53209-1220
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3900 W BROWN DEER RD
Practice Address - Street 2:SUITE A, #212
Practice Address - City:BROWN DEER
Practice Address - State:WI
Practice Address - Zip Code:53209-1220
Practice Address - Country:US
Practice Address - Phone:612-568-4298
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental