Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 4465-15 | WI |
NPI | 1003945528 |
---|---|
Provider Name | Dr. Albert Gallemit Abena |
First Address | Cedarburg, WI 53012-0863 |
Second Address | Milwaukee, WI 53233-2186 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2007 |
Last Update Date | 08/07/2007 |