Provider Demographics
NPI:1457523649
Name:ADVANCED DENTAL CENTER LLC
Entity Type:Organization
Organization Name:ADVANCED DENTAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:414-383-5500
Mailing Address - Street 1:2727 W CLEVELAND AVE
Mailing Address - Street 2:2ND FL
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215
Mailing Address - Country:US
Mailing Address - Phone:414-383-5500
Mailing Address - Fax:414-383-5400
Practice Address - Street 1:2727 W CLEVELAND AVE
Practice Address - Street 2:2ND FL
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-2908
Practice Address - Country:US
Practice Address - Phone:414-383-5500
Practice Address - Fax:414-383-5400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI49111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty