Provider Demographics
NPI:1972550234
Name:MILWAUKEE ORAL SURGERY & IMPLANTS LTD
Entity Type:Organization
Organization Name:MILWAUKEE ORAL SURGERY & IMPLANTS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-257-1161
Mailing Address - Street 1:2323 N MAYFAIR RD
Mailing Address - Street 2:#102
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-1506
Mailing Address - Country:US
Mailing Address - Phone:414-257-1161
Mailing Address - Fax:414-257-0194
Practice Address - Street 1:2323 N MAYFAIR RD
Practice Address - Street 2:#102
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226
Practice Address - Country:US
Practice Address - Phone:414-257-1161
Practice Address - Fax:414-257-0194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38391000Medicaid
WI38391000Medicaid