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General NPI Number Information
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NPI Number | 1487708251
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Entity Type | Organization
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Legal Business Name | AMERICAN DENTAL PROFESSIONALS, S. C.
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 06/17/2011
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Provider Practice Location Address
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Address Line | 2300 N MAYFAIR RD SUITE 920
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City | WAUWATOSA
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State | WI
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Zip | 53226-1505
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Country | US
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Telephone | 414-257-1230
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Fax | 414-257-3208
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Provider Business Mailing Address
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Address Line | 2300 N MAYFAIR RD SUITE 920
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City | WAUWATOSA
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State | WI
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Zip | 53226-1505
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Country | US
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Telephone | 414-257-1230
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Fax | 414-257-3208
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHUAN LI
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Credential | D.M.D.
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Telephone | 414-257-1230
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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 | 5001135
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6488015
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License Number State | WI
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