Provider Demographics
NPI:1235247834
Name:ORAL AND MAXILLOFACIAL SURGERY ASSOCIATES OF WAUKESHA, LTD.
Entity Type:Organization
Organization Name:ORAL AND MAXILLOFACIAL SURGERY ASSOCIATES OF WAUKESHA, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:NOVAK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:262-547-8665
Mailing Address - Street 1:1111 DELAFIELD ST
Mailing Address - Street 2:SUITE 222
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-3403
Mailing Address - Country:US
Mailing Address - Phone:262-547-8665
Mailing Address - Fax:262-547-4328
Practice Address - Street 1:1111 DELAFIELD ST
Practice Address - Street 2:SUITE 222
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-3403
Practice Address - Country:US
Practice Address - Phone:262-547-8665
Practice Address - Fax:262-547-4328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty