Provider Demographics
NPI:1548066046
Name:GOOD LAND DENTAL MKE, LLC
Entity type:Organization
Organization Name:GOOD LAND DENTAL MKE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:G
Authorized Official - Last Name:BEHLMER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:414-779-1058
Mailing Address - Street 1:816 N 67TH ST
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-3905
Mailing Address - Country:US
Mailing Address - Phone:414-779-1058
Mailing Address - Fax:
Practice Address - Street 1:9122 W CENTER ST STE 2
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-4600
Practice Address - Country:US
Practice Address - Phone:414-774-0120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental