Provider Demographics
NPI:1861793812
Name:AFFORDABLE DENTURES - MILWAUKEE, S.C.
Entity type:Organization
Organization Name:AFFORDABLE DENTURES - MILWAUKEE, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:414-604-2055
Mailing Address - Street 1:6015 W FOREST HOME AVE STOP 1
Mailing Address - Street 2:
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:414-604-2054
Practice Address - Street 1:6015 W FOREST HOME AVE STOP 1
Practice Address - Street 2:
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:414-604-2054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-08
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty