Provider Demographics
NPI:1255404844
Name:VINEYARD FAMILY DENTAL,S.C.
Entity type:Organization
Organization Name:VINEYARD FAMILY DENTAL,S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHUL-HA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAIK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:414-351-6161
Mailing Address - Street 1:7410 N TEUTONIA AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-2008
Mailing Address - Country:US
Mailing Address - Phone:414-351-6161
Mailing Address - Fax:414-351-6162
Practice Address - Street 1:7410 N TEUTONIA AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53209-2008
Practice Address - Country:US
Practice Address - Phone:414-351-6161
Practice Address - Fax:414-351-6162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI57910151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty