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General NPI Number Information
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NPI Number | 1215074604
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Entity Type | Organization
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Legal Business Name | AMERICAN DENTAL PROFESSIONAL SERVICES, LLC
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 9054 N DEERBROOK TRL
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City | MILWAUKEE
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State | WI
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Zip | 53223-2474
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Country | US
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Telephone | 414-203-2590
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Fax | 414-354-1945
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Provider Business Mailing Address
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Address Line | 9054 N DEERBROOK TRL
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City | MILWAUKEE
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State | WI
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Zip | 53223-2474
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Country | US
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Telephone | 414-203-2590
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Fax | 414-354-1945
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Authorized Official
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Title or Position | PRESIDENT
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Name | TERRI M LAWLER
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Credential |
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Telephone | 414-203-2590
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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