Provider Demographics
NPI:1528424124
Name:AFFORDABLE DENTURES - MILWAUKEE III, S.C.
Entity type:Organization
Organization Name:AFFORDABLE DENTURES - MILWAUKEE III, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS/PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-604-2055
Mailing Address - Street 1:6015 W FOREST HOME AVE
Mailing Address - Street 2:UNIT 1
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53220-1992
Mailing Address - Country:US
Mailing Address - Phone:414-604-2055
Mailing Address - Fax:
Practice Address - Street 1:6015 W FOREST HOME AVE
Practice Address - Street 2:UNIT 1
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53220-1992
Practice Address - Country:US
Practice Address - Phone:414-604-2055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-12
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6587-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty