| Great Lakes Oral & Maxillofacial Surgery, P.a. | |
|
227 Meridian Dr # 6 New Richmond WI 54017-2565 | |
| (715) 246-5150 | |
| (715) 246-5102 |
| Full Name | Great Lakes Oral & Maxillofacial Surgery, P.a. |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 227 Meridian Dr # 6, New Richmond, Wisconsin |
| Authorized Official Name and Position | Connie Louise Miller (PRACTICE MANAGER) |
| Authorized Official Contact | 6513511010 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Great Lakes Oral & Maxillofacial Surgery, P.a. 227 Meridian Dr # 6 New Richmond WI 54017-2565 Ph: (715) 246-5150 | Great Lakes Oral & Maxillofacial Surgery, P.a. 227 Meridian Dr # 6 New Richmond WI 54017-2565 Ph: (715) 246-5150 |
| NPI Number | 1205136074 |
|---|---|
| Provider Enumeration Date | 10/27/2010 |
| Last Update Date | 10/27/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205136074 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 4482 (Wisconsin) | Primary |
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