Community Oral and Maxillofacial Surgery, LLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

COMMUNITY ORAL AND MAXILLOFACIAL SURGERY, LLC

Practice address

408 W Florida St Ste 105
Milwaukee, WI 53204-1509

Phone

(401) 401-4141

NPI assigned

Aug 19, 2021

Organization subpart

No

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

Authorized official

Name

Ruba Khader, BDSNPI 1992976427

Title

Owner

Phone

(414) 810-1707

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Ruba Naim Khader, BDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Milwaukee, WI
  • NPI 1992976427
  NPD Authorized official

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

{
    "created_epoch": "1629331200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669680000000",
    "number": "1962178970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "408 W FLORIDA ST STE 105",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532041509",
            "telephone_number": "414-810-1707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "408 W FLORIDA ST STE 105",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532041509",
            "telephone_number": "401-401-4141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY ORAL AND MAXILLOFACIAL SURGERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-19",
        "last_updated": "2022-11-29",
        "certification_date": "2022-11-04",
        "status": "A",
        "authorized_official_last_name": "KHADER",
        "authorized_official_first_name": "RUBA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "414-810-1707",
        "authorized_official_credential": "BDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community Medical Supply Company
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• Community Support Services LLC
• Community Transportation
• Community Transportation Advantage LLC

• Oral and Maxillofacial Surgery (Dentist) in Milwaukee, WI
• Providers in Milwaukee, 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 Nov 29, 2022; 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.