Provider Demographics
NPI:1841988565
Name:AWS DENTAL, LLC
Entity type:Organization
Organization Name:AWS DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:SILVIA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:859-913-5706
Mailing Address - Street 1:N66W4905 CEDAR RESERVE CIR
Mailing Address - Street 2:
Mailing Address - City:CEDARBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53012-3509
Mailing Address - Country:US
Mailing Address - Phone:859-913-5706
Mailing Address - Fax:
Practice Address - Street 1:11345 N PORT WASHINGTON RD FL 1
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-3411
Practice Address - Country:US
Practice Address - Phone:262-241-4440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental