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General NPI Number Information
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NPI Number | 1770293060
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Entity Type | Organization
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Legal Business Name | TRANQUIL PROPHY LLC
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Dates
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Enumeration Date | 11/29/2022
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Last Update Date | 11/29/2022
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Provider Practice Location Address
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Address Line | 3717 S 56TH ST
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City | GREENFIELD
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State | WI
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Zip | 53220-2046
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Country | US
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Telephone | 414-982-9163
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Fax |
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Provider Business Mailing Address
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Address Line | 3717 S 56TH ST
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City | GREENFIELD
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State | WI
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Zip | 53220-2046
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | HYGIENIST
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Name | MRS. LIEN JANICK
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Credential | RDH
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Telephone | 414-982-9163
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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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