MEDICARE: ADVANCED DENTAL CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	4911	WI

General Provider Information

NPI Number	:	1457523649
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED DENTAL CENTER LLC

Provider Business Mailing Address
First Line	:	2727 W CLEVELAND AVE
Second Line	:	2ND FL
City	:	MILWAUKEE
State	:	WI
Zip	:	53215
Country	:	US
Telephone Number	:	414-383-5500
Fax Number	:	414-383-5400

Provider Business Practice Location Address
First Line	:	2727 W CLEVELAND AVE
Second Line	:	2ND FL
City	:	MILWAUKEE
State	:	WI
Zip	:	53215-2908
Country	:	US
Telephone Number	:	414-383-5500
Fax Number	:	414-383-5400

Authorized Official
Title or Position	:	DDS
Name	:	DR. LARRY TRAN
Credential	:	DDS
Telephone Number	:	414-383-5500

Provider Enumeration Date	:	03/27/2008
Last Update Date	:	03/27/2008

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