Healthcare Provider Details

I. General information

NPI: 1437737673
Provider Name (Legal Business Name): MIER DENTAL ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 04/09/2021
Certification Date: 04/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3216 S 92ND ST STE 104
MILWAUKEE WI
53227-4577
US

IV. Provider business mailing address

3216 S 92ND ST STE 104
MILWAUKEE WI
53227-4577
US

V. Phone/Fax

Practice location:
  • Phone: 414-885-6140
  • Fax:
Mailing address:
  • Phone: 414-885-6140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: MS. VANESSA GONZALEZ
Title or Position: PRESIDENT
Credential:
Phone: 949-335-8569