Wisconsin Oral & Maxillofacial Surgery LLC

Primary specialty

Oral and Maxillofacial Surgery Clinic/CenterTaxonomy code 261QS0112X

Legal business name

WISCONSIN ORAL & MAXILLOFACIAL SURGERY LLC

Practice address

2603 W Rawson Ave Ste 123
Oak Creek, WI 53154-8422

Phone

(914) 325-5672

NPI assigned

Jun 5, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Ejlal Alalawi, DMD

Title

Owner/Provider

Phone

(914) 325-5672

Specialties & licenses 2

Addresses

Other names 1

• White Oak Dental Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1528156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1528156800000",
    "number": "1013409002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 LEGEND WAY",
            "city": "WALES",
            "state": "WI",
            "postal_code": "531839539",
            "telephone_number": "914-325-5672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2603 W RAWSON AVE STE 123",
            "city": "OAK CREEK",
            "state": "WI",
            "postal_code": "531548422",
            "telephone_number": "914-325-5672"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WISCONSIN ORAL & MAXILLOFACIAL SURGERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-05",
        "last_updated": "2018-06-05",
        "status": "A",
        "authorized_official_last_name": "ALALAWI",
        "authorized_official_first_name": "EJLAL",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "914-325-5672",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QS0112X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "White Oak Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Deana L S Wilson, PSYD
• Wisconsin CVS Pharmacy LLC
• Wisconsin Dental Group, S.C.
• Wisconsin Lutheran Child & Family Service, Inc
• Wisconsin Neurology Clinic, LLC
• Wisconsin Orthotics & Prosthetics Center LLC
• Stephanie Lynn Witt
• Catherine Ann Woehlck, LPC
• Lisa Wolf, MD
• Joseph M Wolfe, MD

• All providers in Oak Creek, WI
• Oral and Maxillofacial Surgery Clinic/Center in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.