Premier Oral & Maxillofacial Surgery S.C.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

5E10250 Issued in WI

Legal business name

PREMIER ORAL & MAXILLOFACIAL SURGERY S.C.

Practice address

1602 N Randall Ave
Janesville, WI 53545-1124

Phone

(608) 756-8744

Fax

(608) 756-5344

NPI assigned

Sep 26, 2006

Organization subpart

No

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

Authorized official

Name

Crystal M Dieter

Title

Manager

Phone

(608) 756-8744

Specialties & licenses 1

Addresses

Other names 1

• Southern Wisconsin Oral & Maxillofacial Surgery S.C. Former legal business name

Locations

Practitioners 2

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

• Terry D Cisler, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Janesville, WI
  • NPI 1164523742
  NPD (past)
• Kelly Ruth Magliocca, DDS

  • Clinical Pathology Physician
  • Madison, WI
  • NPI 1225131162

  Oral and Maxillofacial Surgery

  NPD (past)

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1339372800000",
    "number": "1992806269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1602 N RANDALL AVE",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535451124",
            "telephone_number": "608-756-8744",
            "fax_number": "608-756-5344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1602 N RANDALL AVE",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535451124",
            "telephone_number": "608-756-8744",
            "fax_number": "608-756-5344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER ORAL & MAXILLOFACIAL SURGERY S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-26",
        "last_updated": "2012-06-11",
        "status": "A",
        "authorized_official_last_name": "DIETER",
        "authorized_official_first_name": "CRYSTAL",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "608-756-8744"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WI",
            "license": "5E10250",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern Wisconsin Oral & Maxillofacial Surgery S.C.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Candace Jordan Pope
• Robert L. Popian, PTA
• Eric Popp, DDS
• Christian J Posner, MD, PHD
• Lacy J Posselt, BS, MS, LPC, LMFT-IT
• Kristy Kay Prentice Kerl, RDH
• Deidre Pribek, PA-C
• Robert M Prijic, DDS
• Calli A. Prindle, OT
• Scott M Priske, DC

• Oral and Maxillofacial Surgery (Dentist) in Janesville, WI
• Providers in Janesville, 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 Jun 11, 2012; 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.