Sheboygan Oral and Maxillofacial Assoc LTD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

SHEBOYGAN ORAL AND MAXILLOFACIAL ASSOC LTD

Practice address

.3637 Wilgus Avenue
Sheboygan, WI 53081

Phone

(920) 458-8213

Fax

(920) 459-9797

NPI assigned

May 4, 2006

Last updated

Jan 21, 2009By 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

Dr. John Jay Keller, DDSNPI 1952350738

Title

President

Phone

(920) 458-8213

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• John Jay Keller, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Sheboygan, WI
  • NPI 1952350738
  Authorized official Same address or phone

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

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1232496000000",
    "number": "1306894134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3637 WILGUS AVENUE",
            "city": "SHEBOYGAN",
            "state": "WI",
            "postal_code": "53081",
            "telephone_number": "920-458-8213",
            "fax_number": "920-459-9797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": ".3637 WILGUS AVENUE",
            "city": "SHEBOYGAN",
            "state": "WI",
            "postal_code": "53081",
            "telephone_number": "920-458-8213",
            "fax_number": "920-459-9797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHEBOYGAN ORAL AND MAXILLOFACIAL ASSOC LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-04",
        "last_updated": "2009-01-21",
        "status": "A",
        "authorized_official_last_name": "KELLER",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "JAY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "920-458-8213",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38365300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sheboygan Internal Medicine Associates, SC
• Sheboygan Lung Specialists, SC
• Sheboygan Medical Center, LLC
• Sheboygan Medical Center, LLC
• Sheboygan Optical Co. LLC
• Sheboygan Orthopaedic Associates SC
• Sheboygan Orthopaedic Associates SC
• Sheboygan Pediatric Associates SC
• Sheboygan Physicians Group, SC
• Sheboygan Regional Oncology Center, LTD.

• Oral and Maxillofacial Surgery (Dentist) in Sheboygan, WI
• Providers in Sheboygan, 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 Jan 21, 2009; 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.