| Wisconsin Oral & Maxillofacial Surgery Llc | |
|
2603 W Rawson Ave Ste 123 Oak Creek WI 53154-8422 | |
| (914) 325-5672 | |
| Not Available |
| Full Name | Wisconsin Oral & Maxillofacial Surgery Llc |
|---|---|
| Speciality | Clinic/center - Oral And Maxillofacial Surgery |
| Location | 2603 W Rawson Ave Ste 123, Oak Creek, Wisconsin |
| Authorized Official Name and Position | Ejlal Alalawi (OWNER/PROVIDER) |
| Authorized Official Contact | 9143255672 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wisconsin Oral & Maxillofacial Surgery Llc 124 Legend Way Wales WI 53183-9539 Ph: (914) 325-5672 | Wisconsin Oral & Maxillofacial Surgery Llc 2603 W Rawson Ave Ste 123 Oak Creek WI 53154-8422 Ph: (914) 325-5672 |
| NPI Number | 1013409002 |
|---|---|
| Provider Enumeration Date | 06/05/2018 |
| Last Update Date | 06/05/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013409002 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Secondary |
| 261QS0112X | Clinic/center - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
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