| Oral Facial And Periodontal Surgery Llc | |
|
5801 Washington Ave Racine WI 53406 | |
| (262) 886-0147 | |
| Not Available |
| Full Name | Oral Facial And Periodontal Surgery Llc |
|---|---|
| Speciality | Dentist - Periodontics |
| Location | 5801 Washington Ave, Racine, Wisconsin |
| Authorized Official Name and Position | Adrian Rivas (OWNER) |
| Authorized Official Contact | 2628860147 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Oral Facial And Periodontal Surgery Llc 5801 Washington Ave Racine WI 53406 Ph: (262) 886-0147 | Oral Facial And Periodontal Surgery Llc 5801 Washington Ave Racine WI 53406 Ph: (262) 886-0147 |
| NPI Number | 1144772906 |
|---|---|
| Provider Enumeration Date | 10/27/2016 |
| Last Update Date | 10/27/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144772906 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0300X | Dentist - Periodontics | 7006-15 (Wisconsin) | Primary |
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