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General NPI Number Information
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NPI Number | 1225922958
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Entity Type | Organization
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Legal Business Name | MAYFAIR DENTAL CARE: IMPLANTS, ORAL SURGERY AND FAMILY DENTAL S.C.
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Dates
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Enumeration Date | 06/06/2025
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Last Update Date | 06/06/2025
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Provider Practice Location Address
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Address Line | 2200 N MAYFAIR RD
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City | WAUWATOSA
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State | WI
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Zip | 53226-2252
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Country | US
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Telephone | 414-944-1456
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Fax |
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Provider Business Mailing Address
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Address Line | 9134 W SILVER SPRING DR UNIT A
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City | MILWAUKEE
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State | WI
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Zip | 53225-3414
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Country | US
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Telephone | 414-944-1456
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Fax |
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Authorized Official
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Title or Position | MEMBER/PARTNER
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Name | MOHAMMED ALSAMARRAIE
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Credential |
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Telephone | 414-944-1456
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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