| Elmbrook Oral & Maxillofacial Surgery Assoc., S.c. | |
|
12720 W North Ave Brookfield WI 53005-4637 | |
| (262) 784-0053 | |
| (262) 784-0757 |
| Full Name | Elmbrook Oral & Maxillofacial Surgery Assoc., S.c. |
|---|---|
| Speciality | Dentist |
| Location | 12720 W North Ave, Brookfield, Wisconsin |
| Authorized Official Name and Position | Robert A. Wallock (PRESIDENT) |
| Authorized Official Contact | 2627840053 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Elmbrook Oral & Maxillofacial Surgery Assoc., S.c. 12720 W North Ave Brookfield WI 53005-4637 Ph: (262) 784-0053 | Elmbrook Oral & Maxillofacial Surgery Assoc., S.c. 12720 W North Ave Brookfield WI 53005-4637 Ph: (262) 784-0053 |
| NPI Number | 1366586224 |
|---|---|
| Provider Enumeration Date | 02/16/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 5496914574 |
|---|---|
| Medicare Enrollment ID | O20120308000696 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366586224 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 4138-015 (Wisconsin) | Primary |
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