Healthcare Provider Details

I. General information

NPI: 1295647451
Provider Name (Legal Business Name): ANGELO ROSSO LLANTADA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 W WISCONSIN AVE
MILWAUKEE WI
53233-2186
US

IV. Provider business mailing address

1900 NORHARDT DR APT 310
BROOKFIELD WI
53045-5088
US

V. Phone/Fax

Practice location:
  • Phone: 414-288-6790
  • Fax: 414-288-6505
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number87859-875
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: