MEDICARE: UNIVERISTY DENTAL LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	5089-015	MA

General Provider Information

NPI Number	:	1538232202
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERISTY DENTAL LLC

Provider Business Mailing Address
First Line	:	1833 UNIVERSITY AVE
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54302-3637
Country	:	US
Telephone Number	:	920-437-7444
Fax Number	:	920-437-7862

Provider Business Practice Location Address
First Line	:	1833 UNIVERSITY AVE
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54302-3637
Country	:	US
Telephone Number	:	920-437-7444
Fax Number	:	920-437-7862

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DANIEL E TACHE
Credential	:	D.M.D.,F.A.G.D.
Telephone Number	:	920-437-7444

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	08/22/2020

Similar Medicare Providers

1538543319 — DR. ALEXANDER DAVID METZLER DDS
Practice Location Address:

1833 UNIVERSITY AVE
GREEN BAY, WI
54302-3637

Practice Phone: 920-437-7444
Practice Fax: 920-437-7868

1750941522 — DR. MARISA OLIVIA LOW DDS
Practice Location Address:

1833 UNIVERSITY AVE
GREEN BAY, WI
54302-3637

Practice Phone: 920-437-7444
Practice Fax:

1902556558 — DR. MIGUEL SOLORZANO DDS
Practice Location Address:

1833 UNIVERSITY AVE
GREEN BAY, WI
54302-3637

Practice Phone: 920-437-7444
Practice Fax:

1649500992 — NATALIYA VINOKUR M.S/B.S IN OT
Practice Location Address:

25 BAY TER , 14 B
STATEN ISLAND, NY
10306-3637

Practice Phone: 917-318-4798
Practice Fax:

1669946471 — MATTHEW J KAMINSKI PEER SUPPORT
Practice Location Address:

3637 GREEN RD STE 3G
CLEVELAND, OH
44122-5717

Practice Phone: 216-220-8774
Practice Fax:

1982162400 — KAITLYN GENESIS CROSS
Practice Location Address:

3637 GREEN RD STE 3G
BEACHWOOD, OH
44122-5717

Practice Phone: 216-220-8774
Practice Fax:

Directions to “UNIVERISTY DENTAL LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.