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General NPI Number Information
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NPI Number | 1275403495
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Entity Type | Organization
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Legal Business Name | SUSSEX FAMILY DENTAL ASSOCIATES LLC
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Dates
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Enumeration Date | 11/11/2025
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Last Update Date | 11/11/2025
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Provider Practice Location Address
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Address Line | W249N5245 EXECUTIVE DR STE 206
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City | SUSSEX
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State | WI
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Zip | 53089-4393
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Country | US
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Telephone | 262-246-0100
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Fax |
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Provider Business Mailing Address
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Address Line | W249N5245 EXECUTIVE DR STE 206
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City | SUSSEX
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State | WI
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Zip | 53089-4393
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Country | US
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Telephone | 262-246-0100
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | UMAR HAYAT
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Credential | DMD
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Telephone | 610-209-0325
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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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