Great Lakes Oral & Maxillofacial Surgery, P.a.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

4482 Issued in WI

Legal business name

GREAT LAKES ORAL & MAXILLOFACIAL SURGERY, P.A.

Practice address

227 Meridian Dr # 6
New Richmond, WI 54017-2565

Phone

(715) 246-5150

Fax

(715) 246-5102

NPI assigned

Oct 27, 2010

Last updated

Oct 27, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Connie Louise Miller

Title

Practice Manager

Phone

(651) 351-1010

Specialties & licenses 1

Addresses

Tax ID family

Great Lakes Oral Maxillofacial Surgery PA3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Great Lakes Oral & Maxillofacial Surgery, P.a.

  • Oral and Maxillofacial Surgery (Dentist)
  • Hudson, WI
  • NPI 1902116288
  NPD tax ID
• Great Lakes Oral & Maxillofacial Surgery, P.a.

  • Oral and Maxillofacial Surgery (Dentist)
  • Stillwater, MN
  • NPI 1508058322
  NPD tax ID

Locations

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

{
    "created_epoch": "1288137600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288137600000",
    "number": "1205136074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "227 MERIDIAN DR # 6",
            "city": "NEW RICHMOND",
            "state": "WI",
            "postal_code": "540172565",
            "telephone_number": "715-246-5150",
            "fax_number": "715-246-5102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "227 MERIDIAN DR # 6",
            "city": "NEW RICHMOND",
            "state": "WI",
            "postal_code": "540172565",
            "telephone_number": "715-246-5150",
            "fax_number": "715-246-5102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES ORAL & MAXILLOFACIAL SURGERY, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-27",
        "last_updated": "2010-10-27",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "CONNIE",
        "authorized_official_middle_name": "LOUISE",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "651-351-1010",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WI",
            "license": "4482",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Goetzke Chiropractic Inc. (Arch Chiropracitc Center)
• Jamilla Goins, MS, SAC, LPC-IT
• Leo Raymond Gonsowski III, DC, CSCS
• Kimberly Graham
• Brianna Grahovac, MS, LPC-IT
• Ericka Green
• Chad James Griffith, M.D.
• Pamels Jo Grover, COTA
• Joseph Scott Gustafson Sr., LAC
• Arthur A Haines, D.C.

• Oral and Maxillofacial Surgery (Dentist) in New Richmond, WI
• Providers in New Richmond, WI by specialty
• Oral and Maxillofacial Surgery (Dentist) in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2010; 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.