Provider Demographics
NPI:1780601336
Name:DR. RALPH A. PAMENTER S.C.
Entity type:Organization
Organization Name:DR. RALPH A. PAMENTER S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:PAMENTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:262-786-4119
Mailing Address - Street 1:17535 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-4343
Mailing Address - Country:US
Mailing Address - Phone:262-786-4119
Mailing Address - Fax:262-786-0674
Practice Address - Street 1:17535 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-4343
Practice Address - Country:US
Practice Address - Phone:262-786-4119
Practice Address - Fax:262-786-0674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5000813G261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental