Provider Demographics
NPI:1295930634
Name:AMERICAN DENTAL SPECIALTY INSTITUTE, SC
Entity type:Organization
Organization Name:AMERICAN DENTAL SPECIALTY INSTITUTE, SC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ESLAMI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:414-321-7200
Mailing Address - Street 1:2323 S 109TH ST
Mailing Address - Street 2:SUITE 275
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-1909
Mailing Address - Country:US
Mailing Address - Phone:414-321-7200
Mailing Address - Fax:414-321-3232
Practice Address - Street 1:2323 S 109TH ST
Practice Address - Street 2:SUITE 275
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-1909
Practice Address - Country:US
Practice Address - Phone:414-321-7200
Practice Address - Fax:414-321-3232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI32181223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty