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General NPI Number Information
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NPI Number | 1427861921
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Entity Type | Organization
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Legal Business Name | AHP 002 LLC
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Dates
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Enumeration Date | 01/29/2025
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | N67W28025 SUSSEX RD STE 100
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City | HARTLAND
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State | WI
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Zip | 53029-8619
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Country | US
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Telephone | 262-538-0892
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Fax |
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Provider Business Mailing Address
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Address Line | 15285 WATERTOWN PLANK RD STE 200
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City | ELM GROVE
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State | WI
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Zip | 53122-2339
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Country | US
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Telephone | 262-649-4900
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | KATE MANTAY
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Credential |
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Telephone | 262-649-4900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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