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Contact Information

ORAL AND MAXILLOFACIAL SURGERY ASSO OF EAU CLAIRE SC
788 OAKLEAF WAY
ALTOONA, WI54720
 Phone: 715-834-8414
 Fax: 715-834-3557
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Oral & Maxillofacial Surgery

204E00000X 02 Physician/General Surgery
 

Endodontics

1223E0200X
 

Oral and Maxillofacial Surgery

1223S0112X 19 Oral Surgery (Dentist only)
Indicates primary specialty

NPI Profile & details for ORAL AND MAXILLOFACIAL SURGERY ASSO OF EAU CLAIRE SC

NPI Number 1316954928
LBN Legal business name ORAL AND MAXILLOFACIAL SURGERY ASSO OF EAU CLAIRE SC
Authorized official GINA THOR - (TRANSCRIPTION AND CREDENTIALING)
Entity Organization
Organization subpart 1 No
Enumeration date 08/03/2006
Last updated 07/26/2018 - About 8 years ago
Identifiers
WI License # 4412-015
WI License # 4495-015
WI License # 4680-015
WI License # 5112-015
WI License # 5563-015
WI License # 6222-15
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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