Provider Demographics
NPI:1104864529
Name:THE ORAL SURGERY CENTER
Entity Type:Organization
Organization Name:THE ORAL SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATTY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-233-2140
Mailing Address - Street 1:748 BIELENBERG DRIVE
Mailing Address - Street 2:SUITE 160
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125
Mailing Address - Country:US
Mailing Address - Phone:651-233-2140
Mailing Address - Fax:651-738-9048
Practice Address - Street 1:748 BIELENBERG DRIVE
Practice Address - Street 2:SUITE 160
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125
Practice Address - Country:US
Practice Address - Phone:651-233-2140
Practice Address - Fax:651-738-9048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND97441223S0112X
MND111771223S0112X
MND115561223S0112X
WI30290151223S0112X
WI58980151223S0112X
WI58970151223S0112X
204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33797100Medicaid
WI33797200Medicaid
WI33797300Medicaid
MNOTH000Medicare UPIN
WI33797100Medicaid
WI33797300Medicaid