Healthcare Provider Details

I. General information

NPI: 1124032495
Provider Name (Legal Business Name): SAMEER RAMBHIA B.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 W WISCONSIN AVE #004
MILWAUKEE WI
53233-2186
US

IV. Provider business mailing address

519 N 20TH ST #11
MILWAUKEE WI
53233-2535
US

V. Phone/Fax

Practice location:
  • Phone: 414-288-5411
  • Fax:
Mailing address:
  • Phone: 414-431-3267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number13-875
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: