Provider Demographics
NPI:1508939265
Name:SAWYER CREEK ORTHODONTICS
Entity Type:Organization
Organization Name:SAWYER CREEK ORTHODONTICS
Other - Org Name:WILLIAM S SCHUSTIN DDS SC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MASLOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:920-231-4922
Mailing Address - Street 1:2626 W 9TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54904-8127
Mailing Address - Country:US
Mailing Address - Phone:920-231-4922
Mailing Address - Fax:920-231-4803
Practice Address - Street 1:2626 W 9TH AVENUE
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904-8127
Practice Address - Country:US
Practice Address - Phone:920-231-4922
Practice Address - Fax:920-231-4803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50010720151223X0400X
WI52780151223X0400X
WI54870151223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty