Provider Demographics
NPI:1972327435
Name:TRUE DENTAL WEST ALLIS LLC
Entity type:Organization
Organization Name:TRUE DENTAL WEST ALLIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REEM
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHJOUB
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:330-717-0578
Mailing Address - Street 1:13885 LARSEN CT
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-5256
Mailing Address - Country:US
Mailing Address - Phone:330-717-0578
Mailing Address - Fax:
Practice Address - Street 1:932 S 60TH ST
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-3369
Practice Address - Country:US
Practice Address - Phone:414-454-9844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty