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General NPI Number Information
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NPI Number | 1790187417
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Entity Type | Organization
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Legal Business Name | NAJJAR ORTHODONTICS, SC
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Dates
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Enumeration Date | 09/24/2014
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Last Update Date | 09/24/2014
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Provider Practice Location Address
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Address Line | 1421 S 108TH ST
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City | WEST ALLIS
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State | WI
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Zip | 53214-4012
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Country | US
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Telephone | 414-771-5100
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Fax | 414-771-2513
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Provider Business Mailing Address
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Address Line | 1421 S 108TH ST
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City | WEST ALLIS
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State | WI
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Zip | 53214-4012
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Country | US
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Telephone | 414-771-5100
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Fax | 414-771-2513
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANAS AL NAJJAR
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Credential | DMD
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Telephone | 414-771-5100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 100099115
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License Number State | WI
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