NPIMap

Organization Active NPI

Oral Surgery Associates of Milwaukee SC

  • Oral and Maxillofacial Surgery (Dentist)
  • Mequon, WI
National Provider Identifier
1477647832
Registry record updated Jul 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
4130-015 Issued in WI
Legal business name
ORAL SURGERY ASSOCIATES OF MILWAUKEE SC
Practice address
10535 N Port Washington Rd
Suite 102
Mequon, WI 53092-5583
Phone
(262) 241-0900
Fax
(262) 241-0904
NPI assigned
Oct 2, 2006
Last updated
Jul 30, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2025

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

Authorized official

Name
Dr. Alan A Kimmel, DDSNPI 1760576128
Title
Oral & Maxillofacial Surgeon
Phone
(262) 241-0900

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) 1223S0112X 4130-015 WI Primary

Addresses

Primary practice location

10535 N Port Washington Rd
Suite 102
Mequon, WI 53092-5583

Mailing address

10535 N Port Washington Rd
Suite 102
Mequon, WI 53092-5583
Phone (262) 241-0900

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040310000440 WI Part B Supplier - Clinic/Group Practice 9032007091 Receives reassigned benefits from 4 practitioners
2 other NPIs on this enrollment
Practice locations: Oak Creek, WI; Wauwatosa, WI; Mequon, WI

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Oral Surgery Associates of Milwaukee SC3 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.

Locations

10535 N Port Washington Rd
Ste 102
Mequon, WI 53092
Phone (262) 241-0900

6900 W Brown Deer Rd
Milwaukee, WI 53223
Phone (414) 354-3200

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753833600000",
    "number": "1477647832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10535 N PORT WASHINGTON RD",
            "address_2": "SUITE 102",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530925583",
            "telephone_number": "262-241-0900",
            "fax_number": "262-241-0904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10535 N PORT WASHINGTON RD",
            "address_2": "SUITE 102",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530925583",
            "telephone_number": "262-241-0900",
            "fax_number": "262-241-0904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORAL SURGERY ASSOCIATES OF MILWAUKEE SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-02",
        "last_updated": "2025-07-30",
        "certification_date": "2025-07-30",
        "status": "A",
        "authorized_official_last_name": "KIMMEL",
        "authorized_official_first_name": "ALAN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "ORAL & MAXILLOFACIAL SURGEON",
        "authorized_official_telephone_number": "262-241-0900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WI",
            "license": "4130-015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mequon, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2025; 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.