ORAL AND MAXILLOFACIAL SURGERY ASSO OF EAU CLAIRE SC (NPI# 1316954928) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316954928 |
| Entity Type | Organization |
| Organization Name | ORAL AND MAXILLOFACIAL SURGERY ASSO OF EAU CLAIRE SC |
| Other Organization Name | ORAL AND MAXILLOFACIAL SURGERY ASSOCIATES OF EAU CLAIRE SC |
| Practice Address |
788 Oakleaf Way Altoona WI 54720 |
| Mailing Address |
1120 Oak Ridge Drive Eau Claire WI 54701 |
| Practice Telephone | 7158348414 |
| Practice Fax Number | 7158343557 |
| Mailing Telephone | 7158348414 |
| Mailing Fax Number | 7158343557 |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2018-07-26 |
| Authorized Official Name | GINA K THOR (TRANSCRIPTION AND CREDENTIALING) |
| Authorized Official Telephone | 7158348414 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 204E00000X | Oral & Maxillofacial Surgery | 4680-015 | WI | Allopathic & Osteopathic Physicians |
| N | 204E00000X | Oral & Maxillofacial Surgery | 5112-015 | WI | Allopathic & Osteopathic Physicians |
| N | 204E00000X | Oral & Maxillofacial Surgery | 5563-015 | WI | Allopathic & Osteopathic Physicians |
| N | 1223E0200X |
Dentist Specialization: Endodontics |
Dental Providers | ||
| N | 1223E0200X |
Dentist Specialization: Endodontics |
6222-15 | WI | Dental Providers |
| N | 1223E0200X |
Dentist Specialization: Endodontics |
4412-015 | WI | Dental Providers |
| N | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
Dental Providers | ||
| Y | 204E00000X | Oral & Maxillofacial Surgery | 4495-015 | WI | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Oral and Maxillofacial Surgery Associates of Eau Claire SC | Former Legal Business Name - Organization |
| Street Address |
788 OAKLEAF WAY |
| City | ALTOONA |
| State | WI |
| Zip Code | 54720 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619391869 | Stephen Ridenour | Dentist | 788 Oakleaf Way, Altoona, WI 54720 | 2014-02-07 |
| 1639241342 | Slavko Ivankovic | Dentist | 788 Oakleaf Way, Altoona, WI 54720 | 2006-11-15 |
| 1205908936 | M. Drew Millington | Dentist | 788 Oakleaf Way, Altoona, WI 54720 | 2006-11-15 |
| 1447322219 | Jeff Goetz | Dentist | 788 Oakleaf Way, Altoona, WI 54720 | 2006-11-15 |
| 1023027786 | Ian Dozier | Dentist | 788 Oakleaf Way, Altoona, WI 54720 | 2006-08-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982155248 | The Bethany-st. Joseph Corporation D/b/a Prairie Pointe Rehab Suites | Skilled Nursing Facility | 286 N. Willson Dr, Altoona, WI 54720 | 2016-10-20 |
| 1821541046 | Stephanie Meyer | Optometrist | 3063 Meadowlark Ln, #10, Altoona, WI 54720 | 2016-07-25 |
| 1952756991 | Grace Lutheran Foundation Inc | Skilled Nursing Facility | 206 North Willson Drive, Altoona, WI 54720 | 2016-04-27 |
| 1669826095 | Grace Lutheran Foundation Inc | Skilled Nursing Facility | 286 North Willson Dr., Altoona, WI 54720 | 2016-04-22 |
| 1366881781 | Ingrid Ellen Schroeder | Occupational Therapy Assistant | 1203 Bartlett Avenue, Altoona, WI 54720 | 2013-06-19 |
| 1790972099 | Assisted Living Concepts Inc | Assisted Living Facility | 342 Twin Oak Drive, Altoona, WI 54720 | 2007-10-01 |
| 1427262302 | Amanda Lynn Busse | Occupational Therapy Assistant | 2512 New Pine Drive, Altoona, WI 54720 | 2007-05-09 |
| 1740230838 | Jodi Hansen Ritsch | Family Medicine | 1476 Blazing Star Blvd, Suite 4, Altoona, WI 54720 | 2006-05-11 |
| 1225095508 | Kirsten L Taylor | Counselor | 2519 North Hillcrest Parkway, Suite 103, Altoona, WI 54720 | 2006-04-28 |
| 1811977929 | Laura Ann Smith | Pediatrics | 3085 Meadowlark Ln Ste 20, Altoona, WI 54720 | 2006-01-17 |
| Find all providers in zip 54720 | ||||
| Taxonomy Code | 204E00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Oral & Maxillofacial Surgery |
| Oral and maxillofacial surgeons are trained to recognize and treat a wide spectrum of diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region. They are also trained to administer anesthesia, and provide care in an office setting. They are trained to treat problems such as the extraction of wisdom teeth, misaligned jaws, tumors and cysts of the jaw and mouth, and to perform dental implant surgery. |
| Notes: Source: American College of Surgeons, 2013. www.facs.org [7/1/2013: definition added, source added, additional resources added] Additional Resources: American Board of Oral and Maxillofacial Surgery and American Association of Oral and Maxillofacial Surgeons While this is generally considered a specialty of dentistry, physicians can also be board certified as oral and maxillofacial surgeons through the American Board of Oral and Maxillofacial Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003139700 | Dean Tiboris | Oral & Maxillofacial Surgery | 5021 Washington Rd, Kenosha, WI 53144-4292 | 2010-03-09 |
| 1013020866 | Oral Surgery Assoc Ltd | Oral & Maxillofacial Surgery | 464 South Hickory Street, Suite A, Fond Du Lac, WI 54935 | 2006-08-16 |
| 1699822403 | Andrew J Miller | Oral & Maxillofacial Surgery | 752 N High Point Rd, Madison, WI 53717-2236 | 2007-01-04 |
| 1457416299 | Brian J Blocher | Oral & Maxillofacial Surgery | 201 N Mayfair Rd, Suite 520, Wauwatosa, WI 53226 | 2006-12-22 |
| 1770684466 | Colin J Ott | Oral & Maxillofacial Surgery | 2600 Stewart Ave, Ste 266, Wausau, WI 54401 | 2006-09-26 |
| 1932118064 | Robert E Cline | Oral & Maxillofacial Surgery | 2414 Kohler Memorial Dr, Sheboygan, WI 53081 | 2006-08-07 |
| 1912950221 | Marylou C Sabino | Oral & Maxillofacial Surgery | 840 N 87th St, Oral and Maxillofacial Surgery, Milwaukee, WI 53226-3586 | 2006-05-18 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.