Healthcare Provider Details

I. General information

NPI: 1346662426
Provider Name (Legal Business Name): LUIS ALMEIDA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2014
Last Update Date: 12/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 W WISCONSIN AVE SUITE 106
MILWAUKEE WI
53233-2186
US

IV. Provider business mailing address

PO BOX 1881 SCHOOL OF DENTISTRY, 352
MILWAUKEE WI
53201-1881
US

V. Phone/Fax

Practice location:
  • Phone: 414-288-7155
  • Fax:
Mailing address:
  • Phone: 414-288-6022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number17906-875
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number17906-875
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: