| Full Name | |
|---|---|
| Speciality | Oral & Maxillofacial Surgery |
| Location | 788 Oakleaf Way, Altoona, Wisconsin |
| Authorized Official Name and Position | Gina K Thor (TRANSCRIPTION AND CREDENTIALING) |
| Authorized Official Contact | 7158348414 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1120 Oak Ridge Drive Eau Claire WI 54701 Ph: (715) 834-8414 | 788 Oakleaf Way Altoona WI 54720 Ph: (715) 834-8414 |
| NPI Number | 1316954928 |
|---|---|
| Provider Enumeration Date | 08/03/2006 |
| Last Update Date | 07/26/2018 |
| Medicare PECOS PAC ID | 1456355643 |
|---|---|
| Medicare Enrollment ID | O20060830000344 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316954928 | NPI | - | NPPES |
| Provider Name | Slavko Ivankovic |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1639241342 PECOS PAC ID: 1658555388 Enrollment ID: I20110405000244 |
| Provider Name | Mark D Millington |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1205908936 PECOS PAC ID: 2264609759 Enrollment ID: I20120124000949 |
Advanced Endodontics, Sc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 788 Oakleaf Way, Altoona, WI 54720 Phone: 715-834-8414 |