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Contact Information

NORTHWOODS ORAL AND MAXILLOFACIAL SURGERY SC
9762 WEST LAKE AVENUE
MINOCQUA, WI54548
 Phone: 715-358-3321
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dentist

122300000X
Indicates primary specialty

NPI Profile & details for NORTHWOODS ORAL AND MAXILLOFACIAL SURGERY SC

NPI # 1346460441
LBN Legal business name NORTHWOODS ORAL AND MAXILLOFACIAL SURGERY SC
Authorized official JOHN KOSMEN - (DENTIST)
Entity Organization
Organization subpart 1 No
Enumeration date 04/30/2007
Last updated 09/17/2007 - About 19 years ago
Identifiers
WI License # 4694
WI Medicaid 33727700
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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