Provider Demographics
NPI:1386906410
Name:GALLERIA WEST DENTAL S.C.
Entity type:Organization
Organization Name:GALLERIA WEST DENTAL S.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:W
Authorized Official - Last Name:BIEDERWOLF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:262-754-2727
Mailing Address - Street 1:18900 W BLUEMOUND RD
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-6092
Mailing Address - Country:US
Mailing Address - Phone:262-754-2727
Mailing Address - Fax:262-789-6797
Practice Address - Street 1:18900 W BLUEMOUND RD
Practice Address - Street 2:SUITE 218
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-6092
Practice Address - Country:US
Practice Address - Phone:262-754-2727
Practice Address - Fax:262-789-6797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-14
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty