Healthcare Provider Details

I. General information

NPI: 1235689605
Provider Name (Legal Business Name): EVERYONE'S FAMILY DENTAL WESTON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2016
Last Update Date: 10/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2809 SCHOFIELD AVE
WESTON WI
54476-2411
US

IV. Provider business mailing address

2809 SCHOFIELD AVE
WESTON WI
54476-2411
US

V. Phone/Fax

Practice location:
  • Phone: 815-847-9292
  • Fax:
Mailing address:
  • Phone: 815-847-9292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1001408
License Number StateWI

VIII. Authorized Official

Name: DR. JUBRAIL SWEIS
Title or Position: DENTIST/ OWNER
Credential: D.D.S
Phone: 815-847-9292