Oral And Maxillofacial Surgery Asso Of Eau Claire Sc is a medicare enrolled dental clinic (Oral & Maxillofacial Surgery) in Altoona, Wisconsin. The current practice location for Oral And Maxillofacial Surgery Asso Of Eau Claire Sc is 788 Oakleaf Way, Altoona, Wisconsin. For appointments, you can reach them via phone at
(715) 834-8414. The mailing address for Oral And Maxillofacial Surgery Asso Of Eau Claire Sc is 1120 Oak Ridge Drive, Eau Claire, Wisconsin and phone number is (715) 834-8414.
Oral And Maxillofacial Surgery Asso Of Eau Claire Sc is licensed to practice in Wisconsin (license number 4495-015). The clinic also participates in the medicare program and its
NPI number is 1316954928. This medical practice
accepts medicare insurance (which means this clinic accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance). However, please confirm if they accept your insurance at
(715) 834-8414.
Dental Care Clinic Profile
| Full Name | Oral And Maxillofacial Surgery Asso Of Eau Claire Sc |
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| Speciality | Oral & Maxillofacial Surgery |
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| Location | 788 Oakleaf Way, Altoona, Wisconsin |
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| Authorized Official Name and Position | Gina K Thor (TRANSCRIPTION AND CREDENTIALING) |
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| Authorized Official Contact | 7158348414 |
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| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
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Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Oral And Maxillofacial Surgery Asso Of Eau Claire Sc
1120 Oak Ridge Drive
Eau Claire
WI 54701
Ph: (715) 834-8414 | Oral And Maxillofacial Surgery Asso Of Eau Claire Sc
788 Oakleaf Way
Altoona
WI 54720
Ph: (715) 834-8414 |
NPI Details:
| NPI Number | 1316954928 |
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| Provider Enumeration Date | 08/03/2006 |
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| Last Update Date | 07/26/2018 |
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Medicare PECOS Information:
| Medicare PECOS PAC ID | 1456355643 |
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| Medicare Enrollment ID | O20060830000344 |
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Medical Identifiers
Medical identifiers for Oral And Maxillofacial Surgery Asso Of Eau Claire Sc such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1316954928 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 1223E0200X | Dentist - Endodontics | (* (Not Available)) | Secondary |
| 1223E0200X | Dentist - Endodontics | 6222-15 (Wisconsin) | Secondary |
| 1223E0200X | Dentist - Endodontics | 4412-015 (Wisconsin) | Secondary |
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Secondary |
| 204E00000X | Oral & Maxillofacial Surgery | 4495-015 (Wisconsin) | Primary |
| 204E00000X | Oral & Maxillofacial Surgery | 4680-015 (Wisconsin) | Secondary |
| 204E00000X | Oral & Maxillofacial Surgery | 5112-015 (Wisconsin) | Secondary |
| 204E00000X | Oral & Maxillofacial Surgery | 5563-015 (Wisconsin) | Secondary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works.
Oral And Maxillofacial Surgery Asso Of Eau Claire Sc acts as a billing entity for following providers:
| Provider Name | Ian Dozier |
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| Provider Type | Practitioner - Oral Surgery |
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| Provider Identifiers | NPI Number: 1023027786
PECOS PAC ID: 9032116132
Enrollment ID: I20061102000539 |
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| Provider Name | Slavko Ivankovic |
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| Provider Type | Practitioner - Oral Surgery |
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| Provider Identifiers | NPI Number: 1639241342
PECOS PAC ID: 1658555388
Enrollment ID: I20110405000244 |
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| Provider Name | Mark D Millington |
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| Provider Type | Practitioner - Oral Surgery |
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| Provider Identifiers | NPI Number: 1205908936
PECOS PAC ID: 2264609759
Enrollment ID: I20120124000949 |
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| Provider Name | Jeffrey S Goetz |
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| Provider Type | Practitioner - Oral Surgery |
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| Provider Identifiers | NPI Number: 1447322219
PECOS PAC ID: 5496916165
Enrollment ID: I20120406000013 |
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