| Wisconsin Oral Surgery LLC | |
|
10401 W Lincoln Ave Ste 101 West Allis WI 53227-1255 | |
| (414) 327-4130 | |
| Not Available |
| Full Name | Wisconsin Oral Surgery LLC |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Pathology |
| Location | 10401 W Lincoln Ave Ste 101, West Allis, Wisconsin |
| Authorized Official Name and Position | Robert Trettin (PRESIDENT) |
| Authorized Official Contact | 4143572040 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wisconsin Oral Surgery LLC 401 Edgewater Pl Ste 430 Wakefield MA 01880-6225 Ph: (781) 213-0240 | Wisconsin Oral Surgery LLC 10401 W Lincoln Ave Ste 101 West Allis WI 53227-1255 Ph: (414) 327-4130 |
| NPI Number | 1679132815 |
|---|---|
| Provider Enumeration Date | 06/11/2019 |
| Last Update Date | 06/11/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679132815 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | () | Secondary |
| 1223P0106X | Dentist - Oral And Maxillofacial Pathology | () | Primary |
| 1223P0700X | Dentist - Prosthodontics | () | Secondary |
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