Provider Demographics
NPI:1780850263
Name:ORAL SURGERY ASSOCIATES OF MILWAUKEE SC
Entity Type:Organization
Organization Name:ORAL SURGERY ASSOCIATES OF MILWAUKEE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:KORTEBEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-241-0900
Mailing Address - Street 1:7801 S HOWELL AVE
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-2134
Mailing Address - Country:US
Mailing Address - Phone:414-764-2880
Mailing Address - Fax:414-764-2882
Practice Address - Street 1:7801 S HOWELL AVE
Practice Address - Street 2:
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-2134
Practice Address - Country:US
Practice Address - Phone:414-764-2880
Practice Address - Fax:414-764-2882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty