Provider Demographics
NPI:1528871050
Name:AHP 005 LLC
Entity type:Organization
Organization Name:AHP 005 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:KATE
Authorized Official - Middle Name:
Authorized Official - Last Name:MANTAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-649-4900
Mailing Address - Street 1:15285 WATERTOWN PLANK RD STE 200
Mailing Address - Street 2:
Mailing Address - City:ELM GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53122-2339
Mailing Address - Country:US
Mailing Address - Phone:262-649-4900
Mailing Address - Fax:
Practice Address - Street 1:N57W6296 CENTER ST
Practice Address - Street 2:
Practice Address - City:CEDARBURG
Practice Address - State:WI
Practice Address - Zip Code:53012-1906
Practice Address - Country:US
Practice Address - Phone:262-377-5130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1780021642OtherNPI
1447659644OtherNPI