| Center For Oral & Maxillofacial Surgery Sc | |
|
7007 Old Sauk Rd Madison WI 53713 | |
| (608) 833-2060 | |
| (608) 833-1737 |
| Full Name | Center For Oral & Maxillofacial Surgery Sc |
|---|---|
| Speciality | Dentist |
| Location | 7007 Old Sauk Rd, Madison, Wisconsin |
| Authorized Official Name and Position | Gary W. Sweeney (S CORP PRESIDENT) |
| Authorized Official Contact | 6088332060 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Center For Oral & Maxillofacial Surgery Sc 20 S Park St #506 Madison WI 53715 Ph: (608) 256-1961 | Center For Oral & Maxillofacial Surgery Sc 7007 Old Sauk Rd Madison WI 53713 Ph: (608) 833-2060 |
| NPI Number | 1710900808 |
|---|---|
| Provider Enumeration Date | 07/26/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 5294830451 |
|---|---|
| Medicare Enrollment ID | O20070417000195 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710900808 | NPI | - | NPPES |
| 38390400 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
| Provider Name | Andrew J Kramer |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1144259581 PECOS PAC ID: 2163526047 Enrollment ID: I20070403000027 |
| Provider Name | Geoffrey R Warda |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1588699664 PECOS PAC ID: 8123123395 Enrollment ID: I20070614000360 |
| Provider Name | Mark K Jackson |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1598788796 PECOS PAC ID: 6305941576 Enrollment ID: I20070618000206 |
| Provider Name | Kim J Pansegrau |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1518990167 PECOS PAC ID: 0941305114 Enrollment ID: I20070712000018 |
| Provider Name | Rhys P Strasia |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1629240296 PECOS PAC ID: 9638310436 Enrollment ID: I20130719000649 |
| Provider Name | Tj A Dyer |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1376809129 PECOS PAC ID: 6901038066 Enrollment ID: I20160610000329 |
| Provider Name | Scott R Goldberg |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1457693772 PECOS PAC ID: 0143451385 Enrollment ID: I20180606000250 |
| Provider Name | Michael J Isaac |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1578884912 PECOS PAC ID: 2769514389 Enrollment ID: I20220620000336 |
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