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Contact Information

ADVANCE DENTAL MANAGEMENT
720 N ROCHESTER ST
SUITE 203
MUKWONAGO, WI53149-1188
 Phone: 262-363-2220
 Fax: 262-363-2221
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

General Practice

1223G0001X
Indicates primary specialty

NPI Profile & details for ADVANCE DENTAL MANAGEMENT

NPI Number 1417020454
LBN Legal business name ADVANCE DENTAL MANAGEMENT
Authorized official GENIE KUBLE - (CONTACT OFFICER)
Entity Organization
Organization subpart 1 No
Enumeration date 11/16/2006
Last updated 08/22/2020 - About 6 years ago
Identifiers
WI License # 5000526
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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