Wisconsin Oral Surgery LLC

Primary specialty

Oral and Maxillofacial Pathology DentistryTaxonomy code 1223P0106X

Legal business name

WISCONSIN ORAL SURGERY LLC

Practice address

10401 W Lincoln Ave Ste 101
West Allis, WI 53227-1255

Phone

(414) 327-4130

NPI assigned

Jun 11, 2019

Last updated

Jun 11, 2019By the provider in NPPES

Organization subpart

Yes

Parent organization

ADVANCED DENTAL SPECIALISTS, LLCAs reported in NPPES

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

Authorized official

Name

Dr. Robert Trettin, DDS

Title

President

Phone

(414) 357-2040

Specialties & licenses 3

Addresses

Part of

Advanced Dental Specialists LLC

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Advanced Dental Specialists, LLC

  dba Advanced Dental Specialists

  • Oral and Maxillofacial Surgery (Dentist)
  • Milwaukee, WI
  • NPI 1972773588
  NPPES parent name

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.

• Madhavi Potluri, D.M.D

  • Dentist
  • Phoenix, AZ
  • NPI 1275704249
  NPD (past)

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

{
    "created_epoch": "1560211200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560211200000",
    "number": "1679132815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 EDGEWATER PL STE 430",
            "city": "WAKEFIELD",
            "state": "MA",
            "postal_code": "018806225",
            "telephone_number": "781-213-0240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10401 W LINCOLN AVE STE 101",
            "city": "WEST ALLIS",
            "state": "WI",
            "postal_code": "532271255",
            "telephone_number": "414-327-4130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WISCONSIN ORAL SURGERY LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ADVANCED DENTAL SPECIALISTS, LLC",
        "enumeration_date": "2019-06-11",
        "last_updated": "2019-06-11",
        "status": "A",
        "authorized_official_last_name": "TRETTIN",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "414-357-2040",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0106X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Pathology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wisconsin CVS Pharmacy LLC (CVS Pharmacy #17277)
• Wisconsin CVS Pharmacy LLC (CVS Pharmacy #05676)
• Wisconsin Dental Group, S.C. (ForwardDental West Allis)
• Wisconsin Medical Group
• Wisconsin Oral Surgery & Dental Implants, S.C.
• Wisconsin Renal Care Group, L.L.C. (WRCG Centre Point)
• Wisconsin Vision, LLC
• Ashly Marie Witkowiak, LCSW
• Steven Wittig, P.T.
• Sarah Wittmann, LPC

• Oral and Maxillofacial Pathology Dentistry in West Allis, WI
• Providers in West Allis, WI by specialty
• Oral and Maxillofacial Pathology Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; 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.