Oral & Maxillofacial Surgery Consultants of Wisconsin, S.C.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

2699 Issued in WI

Legal business name

ORAL & MAXILLOFACIAL SURGERY CONSULTANTS OF WISCONSIN, S.C.

Practice address

4811 S 76TH St
Suite 304
Greenfield, WI 53220-4364

Phone

(414) 281-3344

Fax

(414) 281-1080

NPI assigned

Jul 30, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Ronald Henry Nellen, DDS

Title

President

Phone

(414) 281-3344

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1154217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1285649921",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4811 S 76TH ST",
            "address_2": "SUITE 304",
            "city": "GREENFIELD",
            "state": "WI",
            "postal_code": "532204364",
            "telephone_number": "414-281-3344",
            "fax_number": "414-281-1080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4811 S 76TH ST",
            "address_2": "SUITE 304",
            "city": "GREENFIELD",
            "state": "WI",
            "postal_code": "532204364",
            "telephone_number": "414-281-3344",
            "fax_number": "414-281-1080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORAL & MAXILLOFACIAL SURGERY CONSULTANTS OF WISCONSIN, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "NELLEN",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "HENRY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "414-281-3344",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WI",
            "license": "2699",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Olson, MD
• Omalley Dentistry SC
• Hamza Omar
• Ophthalmology Associates S C
• Bisrat Oqubay
• Melanie J Orlando
• Kathryn Rose Ortin, OTR
• Derek J Orton, MD
• Jeffrey A Osbourne, DPM
• Randall Curtiss Pack, DDS

• All providers in Greenfield, WI
• Oral and Maxillofacial Surgery (Dentist) in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.