Provider Demographics
NPI:1295782555
Name:MCFARLANE, MICHAEL W (DDS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
Last Name:MCFARLANE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1875 WEST POINTE DR.
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54902
Mailing Address - Country:US
Mailing Address - Phone:920-231-4600
Mailing Address - Fax:920-231-4559
Practice Address - Street 1:1875 WEST POINTE DR.
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54902
Practice Address - Country:US
Practice Address - Phone:920-231-4600
Practice Address - Fax:920-231-4559
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5000545-0151223S0112X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIT62720Medicare UPIN