| Apple Creek Oral Surgery, Sc | |
|
2410 East Evergreen Drive Appleton WI 54913 | |
| (920) 832-9500 | |
| Not Available |
| Full Name | Apple Creek Oral Surgery, Sc |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Pathology |
| Location | 2410 East Evergreen Drive, Appleton, Wisconsin |
| Authorized Official Name and Position | Timothy J Koll (PRESIDENT) |
| Authorized Official Contact | 9208329500 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Apple Creek Oral Surgery, Sc 2410 E. Evergreen Drive Appleton WI 54913 Ph: (920) 832-9500 | Apple Creek Oral Surgery, Sc 2410 East Evergreen Drive Appleton WI 54913 Ph: (920) 832-9500 |
| NPI Number | 1275753659 |
|---|---|
| Provider Enumeration Date | 04/26/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275753659 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0106X | Dentist - Oral And Maxillofacial Pathology | 4243 (Wisconsin) | Primary |
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