Provider Demographics
NPI:1831545763
Name:PARAMOUNT PEDIATRIC DENTISTRY SC
Entity type:Organization
Organization Name:PARAMOUNT PEDIATRIC DENTISTRY SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:L
Authorized Official - Last Name:FRADY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:414-529-1110
Mailing Address - Street 1:11035 W FOREST HOME AVE
Mailing Address - Street 2:SUITE116
Mailing Address - City:HALES CORNERS
Mailing Address - State:WI
Mailing Address - Zip Code:53130-2541
Mailing Address - Country:US
Mailing Address - Phone:414-529-1110
Mailing Address - Fax:414-529-1134
Practice Address - Street 1:11035 W FOREST HOME AVE
Practice Address - Street 2:SUITE116
Practice Address - City:HALES CORNERS
Practice Address - State:WI
Practice Address - Zip Code:53130-2541
Practice Address - Country:US
Practice Address - Phone:414-529-1110
Practice Address - Fax:414-529-1134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-10
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI62191223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty