NPIMap

Organization Active NPI

Oral and Maxillofacial Surgery Associates of Waukesha, LTD.

  • Oral and Maxillofacial Surgery (Dentist)
  • Waukesha, WI
National Provider Identifier
1235247834
Registry record updated Aug 21, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
Legal business name
ORAL AND MAXILLOFACIAL SURGERY ASSOCIATES OF WAUKESHA, LTD.
Practice address
1111 Delafield St
Suite 222
Waukesha, WI 53188-3403
Phone
(262) 547-8665
Fax
(262) 547-4328
NPI assigned
Aug 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2012

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

Authorized official

Name
Dr. Timothy Stephen Novak, D.D.S.NPI 1194832824
Title
President
Phone
(262) 547-8665

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X SINGLE SPECIALTY GROUP 1223S0112X Primary

Addresses

Primary practice location

1111 Delafield St
Suite 222
Waukesha, WI 53188-3403

Mailing address

1111 Delafield St
Suite 222
Waukesha, WI 53188-3403
Phone (262) 547-8665

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050721000128 WI Part B Supplier - Clinic/Group Practice 0244267227 Receives reassigned benefits from 8 practitioners
Practice locations: Johnson Creek, WI; Mukwonago, WI; Oconomowoc, WI; Slinger, WI; Waukesha, WI

National Provider Directory

National Provider Directory

Locations

39 S 3rd St W
Fort Atkinson, WI 53538
Phone (920) 563-7321

475 Hartwig Blvd
Ste 100
Johnson Creek, WI 53038
Phone (920) 699-3730

400 Bay View Rd
Ste H
Mukwonago, WI 53149
Phone (262) 363-1936

320 Bay View Rd
Mukwonago, WI 53149
Phone (262) 368-2980

785 Summit Ave
Ste 302
Oconomowoc, WI 53066
Phone (262) 567-9167

100 E Commerce Blvd
Ste B
Slinger, WI 53086
Phone (262) 222-5599

1513 Doctors Ct
Watertown, WI 53094
Phone (920) 261-8808

1111 Delafield St
Ste 222
Waukesha, WI 53188
Phone (262) 547-8665

1111 Delafield St
Ste 321
Waukesha, WI 53188
Phone (262) 446-0955

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1345507200000",
    "number": "1235247834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 DELAFIELD ST",
            "address_2": "SUITE 222",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531883403",
            "telephone_number": "262-547-8665",
            "fax_number": "262-547-4328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 DELAFIELD ST",
            "address_2": "SUITE 222",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531883403",
            "telephone_number": "262-547-8665",
            "fax_number": "262-547-4328"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORAL AND MAXILLOFACIAL SURGERY ASSOCIATES OF WAUKESHA, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-25",
        "last_updated": "2012-08-21",
        "status": "A",
        "authorized_official_last_name": "NOVAK",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "STEPHEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "262-547-8665",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waukesha, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.