Organization · Type 2 NPI
Central Wisconsin Oral and Facial Surgery, LLC
Oral and Maxillofacial Surgery (Dentist) · Antigo, WI
NPI number
1477065787
Active
Practice location
438 Edison St
Antigo, WI 54409-1845
Mailing address
968 Ribaut Rd Ste 3
Beaufort, SC 29902-8002
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Oral and Maxillofacial Surgery (Dentist) Primary | 1223S0112X | 5831-15 (WI) |
Oral and Maxillofacial Surgery (Dentist): The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.
About NPI 1477065787
Central Wisconsin Oral and Facial Surgery, LLC's National Provider Identifier is 1477065787, issued on Oct 26, 2017. The primary taxonomy on file is Oral and Maxillofacial Surgery (Dentist) (1223S0112X), and the practice location is in Antigo, WI. The record was last updated on Oct 26, 2017.