Provider Demographics
NPI:1801676721
Name:GRANDVIEW DENTAL LLC
Entity type:Organization
Organization Name:GRANDVIEW DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:AIUPPA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:414-412-8948
Mailing Address - Street 1:5449 S SUNNY SLOPE RD
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-8075
Mailing Address - Country:US
Mailing Address - Phone:414-412-8948
Mailing Address - Fax:
Practice Address - Street 1:811 N GRANDVIEW BLVD
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-2803
Practice Address - Country:US
Practice Address - Phone:414-412-8948
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental