Provider Demographics
NPI:1750730495
Name:NEU FAMILY DENTISTRY, S.C.
Entity type:Organization
Organization Name:NEU FAMILY DENTISTRY, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:NEU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:414-258-8444
Mailing Address - Street 1:2600 N MAYFAIR RD
Mailing Address - Street 2:SUITE 450
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-1309
Mailing Address - Country:US
Mailing Address - Phone:414-258-8444
Mailing Address - Fax:414-258-9121
Practice Address - Street 1:2600 N MAYFAIR RD
Practice Address - Street 2:SUITE 450
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-1309
Practice Address - Country:US
Practice Address - Phone:414-258-8444
Practice Address - Fax:414-258-9121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5768-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty