Great Lakes Oral & Maxillofacial Surgery, P.a.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

4482 Issued in WI

Legal business name

GREAT LAKES ORAL & MAXILLOFACIAL SURGERY, P.A.

Practice address

1200 Crest View Dr Ste 1
Hudson, WI 54016-9391

Phone

(715) 381-7070

Fax

(715) 381-0383

NPI assigned

Oct 20, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Richard William Brunton, D.D.S.NPI 1235128992

Title

President

Phone

(651) 351-1010

Specialties & licenses 1

Addresses

Tax ID family

Great Lakes Oral Maxillofacial Surgery PA3 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.

• Great Lakes Oral & Maxillofacial Surgery, P.a.

  • Oral and Maxillofacial Surgery (Dentist)
  • New Richmond, WI
  • NPI 1205136074
  NPD tax ID
• Great Lakes Oral & Maxillofacial Surgery, P.a.

  • Oral and Maxillofacial Surgery (Dentist)
  • Stillwater, MN
  • NPI 1508058322
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Richard William Brunton, D.D.S.

  • Oral and Maxillofacial Surgery (Dentist)
  • Stillwater, MN
  • NPI 1235128992
  NPD (past) Authorized official

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

{
    "created_epoch": "1287532800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1287532800000",
    "number": "1902116288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 CREST VIEW DR STE 1",
            "city": "HUDSON",
            "state": "WI",
            "postal_code": "540169391",
            "telephone_number": "715-381-7070",
            "fax_number": "715-381-0383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 CREST VIEW DR STE 1",
            "city": "HUDSON",
            "state": "WI",
            "postal_code": "540169391",
            "telephone_number": "715-381-7070",
            "fax_number": "715-381-0383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES ORAL & MAXILLOFACIAL SURGERY, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-20",
        "last_updated": "2010-10-20",
        "status": "A",
        "authorized_official_last_name": "BRUNTON",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "651-351-1010",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WI",
            "license": "4482",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Richard Graham, HIS/HID
• Cynthia A Grajkowski, MS ED LMFT
• Gillian Grancorvitz, APRN, PMHNP
• Grandview Dental S.C.
• Dawn Marie Gray
• Great River Orthodontic Specialists, SC
• Paul Raymond Greeder, PHARMD
• Beverly Ann Green, MSSW
• Sarah Sue Greene, OTR/L
• Lindsey Ellen Grega, DPT

• Oral and Maxillofacial Surgery (Dentist) in Hudson, WI
• Providers in Hudson, 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 Oct 20, 2010; 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.