Provider Demographics
NPI:1245374362
Name:ORAL SURGERY CENTER, S.C.
Entity type:Organization
Organization Name:ORAL SURGERY CENTER, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERICH
Authorized Official - Middle Name:
Authorized Official - Last Name:HERBST
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:608-356-2112
Mailing Address - Street 1:1203 8TH ST
Mailing Address - Street 2:
Mailing Address - City:BARABOO
Mailing Address - State:WI
Mailing Address - Zip Code:53913-1805
Mailing Address - Country:US
Mailing Address - Phone:608-356-2112
Mailing Address - Fax:608-356-0919
Practice Address - Street 1:1203 8TH ST
Practice Address - Street 2:
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913-1805
Practice Address - Country:US
Practice Address - Phone:608-356-2112
Practice Address - Fax:608-356-0919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38382200Medicaid
518579OtherDEANCARE PROVIDER #