Provider Demographics
NPI:1770293060
Name:TRANQUIL PROPHY LLC
Entity type:Organization
Organization Name:TRANQUIL PROPHY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HYGIENIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LIEN
Authorized Official - Middle Name:
Authorized Official - Last Name:JANICK
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:414-982-9163
Mailing Address - Street 1:3717 S 56TH ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220-2046
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3717 S 56TH ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-2046
Practice Address - Country:US
Practice Address - Phone:414-982-9163
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental