NPIMap

Organization Active NPI

Northwoods Oral and Maxillofacial Surgery SC

  • Dentist
  • Minocqua, WI
National Provider Identifier
1346460441
Registry record updated Sep 17, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
4694 Issued in WI
Legal business name
NORTHWOODS ORAL AND MAXILLOFACIAL SURGERY SC
Practice address
9762 West Lake Avenue
Minocqua, WI 54548
Phone
(715) 358-3321
NPI assigned
Apr 30, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2007

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

Authorized official

Name
John Michael Kosmen, DDSNPI 1679758395
Title
Dentist
Phone
(715) 358-3321

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
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 4694 WI Primary

Addresses

Primary practice location

9762 West Lake Avenue
Minocqua, WI 54548

Mailing address

PO Box 1027
Minocqua, WI 53548
Phone (715) 358-3321

Other identifiers 1

IdentifierTypeStateIssuer
33727700MedicaidWI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1177891200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1189987200000",
    "number": "1346460441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1027",
            "city": "MINOCQUA",
            "state": "WI",
            "postal_code": "53548",
            "telephone_number": "715-358-3321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9762 WEST LAKE AVENUE",
            "city": "MINOCQUA",
            "state": "WI",
            "postal_code": "54548",
            "telephone_number": "715-358-3321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWOODS ORAL AND MAXILLOFACIAL SURGERY SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-30",
        "last_updated": "2007-09-17",
        "status": "A",
        "authorized_official_last_name": "KOSMEN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "715-358-3321",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "WI",
            "license": "4694",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33727700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Minocqua, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2007; 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.