WISCONSIN ORAL SURGERY LLC (NPI# 1679132815) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679132815 |
| Entity Type | Organization |
| Organization Name | WISCONSIN ORAL SURGERY LLC |
| Practice Address |
10401 W Lincoln Ave Ste 101 West Allis WI 53227-1255 |
| Mailing Address |
401 Edgewater Pl Ste 430 Wakefield MA 01880-6225 |
| Practice Telephone | 4143274130 |
| Mailing Telephone | 7812130240 |
| Enumeration Date | 2019-06-11 |
| Last Update Date | 2019-06-11 |
| Authorized Official Name | DR. ROBERT TRETTIN (PRESIDENT) |
| Authorized Official Telephone | 4143572040 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | Y |
| Parent Organization Name | ADVANCED DENTAL SPECIALISTS, LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223P0700X |
Dentist Specialization: Prosthodontics |
Dental Providers | ||
| N | 122300000X | Dentist | Dental Providers | ||
| Y | 1223P0106X |
Dentist Specialization: Oral and Maxillofacial Pathology |
Dental Providers |
| Street Address |
10401 W LINCOLN AVE STE 101 |
| City | WEST ALLIS |
| State | WI |
| Zip Code | 53227-1255 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205451564 | Ginger Renee Bland | Nurse Practitioner | 11133 W. National Avenue, West Allis, WI 53227 | 2020-06-12 |
| 1003312141 | Dynamic Medical Equipment, LLC | Durable Medical Equipment & Medical Supplies | 10236 W National Ave, West Allis, WI 53227 | 2018-04-05 |
| 1932572641 | Alissa Kristine Walker | Specialist/Technologist | 11601 W Lincoln Ave, West Allis, WI 53227 | 2015-11-03 |
| 1396155990 | Bradly Earl Helinski | Physical Therapy Assistant | 3023 S 84th St., Milwaukee, WI 53227 | 2014-05-05 |
| 1609299783 | Amy Renee Rozumalski | Occupational Therapy Assistant | 10150 W. National Ave, Suite 150, Premiere Medical Staffing Services, LLC, Milwaukee, WI 53227 | 2014-01-27 |
| 1497098438 | Kathleen Marie Schneider | Physical Therapy Assistant | 3023 S. 84th Street, Milwaukee, WI 53227 | 2013-03-28 |
| 1760723373 | Lee Ann Schraith | Physical Therapy Assistant | 3023 S. 84th St, Milwaukee, WI 53227 | 2013-03-06 |
| 1740520725 | Samantha Lynn Wozniak | Physical Therapist | 3023 S. 84th St., Milwaukee, WI 53227 | 2013-02-27 |
| 1831434901 | Andrew Paul Roeder | Physical Therapy Assistant | 3023 S. 89th Street, Milwaukee, WI 53227 | 2012-11-30 |
| 1538418116 | Christine Wilford | Social Worker | 2044 S 96th Street, West Allis, WI 53227 | 2012-08-29 |
| Find all providers in zip 53227 | ||||
| Taxonomy Code | 1223P0106X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Pathology |
| The specialty of dentistry and discipline of pathology that deals with the nature, identification, and management of diseases affecting the oral and maxillofacial regions. It is a science that investigates the causes, processes, and effects of these diseases. The practice of oral and maxillofacial pathology includes research and diagnosis of diseases using clinical, radiographic, microscopic, biochemical, or other examinations. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497098255 | Matthew James Midtling | Dentist | 840 N. 87th Streeth, Sargeant Health Center, Milwaukee, WI 53226 | 2013-03-30 |
| 1407057441 | George Chris Panos | Dentist | N 67 W 31027 Club Circle East, Hartland, WI 53029 | 2007-05-29 |
| 1275753659 | Apple Creek Oral Surgery, Sc | Dentist | 2410 East Evergreen Drive, Appleton, WI 54913 | 2007-04-26 |
| 1053440842 | Oakpark Dental - Platteville | Dentist | 1250 N Water St, Platteville, WI 53818-1450 | 2007-03-05 |
| 1225191067 | Ezedin M Sadeghi | Dentist | 8760 N Seneca Rd, Fox Point, WI 53217-2332 | 2006-12-19 |
| 1669558433 | Yeshwant B Rawal | Dentist | 1801 W Wisconsin Ave Rm 322, Milwaukee, WI 53233-2186 | 2006-10-27 |
| 1225137227 | Guy J Jensen | Dentist | 464 S Hickory St, Suite A, Fond Du Lac, WI 54935-5531 | 2006-09-22 |
| 1134235427 | Lmg, Inc | Dentist | 2626 N 76th Street, Suite 101, Wauwatosa, WI 53213-1137 | 2006-08-21 |
| 1730628330 | Lmg Inc | Dentist | 200 W Silver Spring Dr, Suite 310, Milwaukee, WI 53217-5059 | 2017-02-15 |
| 1891234498 | Lmg Inc | Dentist | 6211 Durand Ave, Suite 202, Mount Pleasant, WI 53406-4956 | 2017-02-15 |
| Find all providers with the same taxonomy | ||||
| City | WEST ALLIS |
| Zip Code | 53227 |
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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.