Healthcare Provider Details

I. General information

NPI: 1801907886
Provider Name (Legal Business Name): AHMAD ESLAMI DMD,MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: AHMAD ESLAMI AND TEAM PERIO DMD, MS

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/13/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12770 W NORTH AVE
BROOKFIELD WI
53005-4628
US

IV. Provider business mailing address

12770 W NORTH AVE
BROOKFIELD WI
53005-4628
US

V. Phone/Fax

Practice location:
  • Phone: 414-321-7200
  • Fax: 414-321-3232
Mailing address:
  • Phone: 414-321-7200
  • Fax: 414-321-3232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number3218
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: