| Tmj & Orofacial Pain Treatment Centers Of Wi | |
|
2626 N 76th Street Suite 101 Wauwatosa WI 53213-1137 | |
| (414) 476-9400 | |
| (414) 755-4769 |
| Full Name | Tmj & Orofacial Pain Treatment Centers Of Wi |
|---|---|
| Speciality | Dentist |
| Location | 2626 N 76th Street, Wauwatosa, Wisconsin |
| Authorized Official Name and Position | Jay L Mackman (OWNER-PRESIDENT) |
| Authorized Official Contact | 4144769400 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tmj & Orofacial Pain Treatment Centers Of Wi 2626 N 76th Street Suite 101 Wauwatosa WI 53213-1137 Ph: (414) 476-9400 | Tmj & Orofacial Pain Treatment Centers Of Wi 2626 N 76th Street Suite 101 Wauwatosa WI 53213-1137 Ph: (414) 476-9400 |
| NPI Number | 1134235427 |
|---|---|
| Provider Enumeration Date | 08/21/2006 |
| Last Update Date | 01/19/2017 |
| Medicare PECOS PAC ID | 6305851676 |
|---|---|
| Medicare Enrollment ID | O20060208000608 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134235427 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0106X | Dentist - Oral And Maxillofacial Pathology | (Wisconsin) | Primary |
| Provider Name | Daniel E Tache |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1174669634 PECOS PAC ID: 4082672308 Enrollment ID: I20050103000472 |
| Provider Name | Randall J Mcdaniel |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1518063874 PECOS PAC ID: 2769497965 Enrollment ID: I20060209000094 |
| Provider Name | Jay L Mackman |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1821194184 PECOS PAC ID: 3577549534 Enrollment ID: I20090424000374 |
| Provider Name | Amanda J Shear |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104210988 PECOS PAC ID: 7810217445 Enrollment ID: I20150522000765 |
| Provider Name | Bhavik Dmd Desai |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1790003440 PECOS PAC ID: 0840440160 Enrollment ID: I20191230001704 |
| Provider Name | Connor M Peck |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1821581760 PECOS PAC ID: 6406271709 Enrollment ID: I20200804001292 |
| Provider Name | Aaron K Nisley |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1295391001 PECOS PAC ID: 5698179596 Enrollment ID: I20210813000509 |
| Provider Name | James Robert Luderitz |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1295897114 PECOS PAC ID: 8628041365 Enrollment ID: I20230118001604 |
Jay L. Mackman, Dds Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 2626 N 76th St, Wauwatosa, WI 53213 Phone: 414-476-9400 | |
Generations Family Dental Care-tosa, Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 2505 N Mayfair Rd Ste 103, Wauwatosa, WI 53226 Phone: 414-258-2117 Fax: 414-258-4117 | |
Wauwatosa Dental Group Sc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 2600 N Mayfair Rd, Suite 750, Wauwatosa, WI 53226 Phone: 414-257-3366 Fax: 414-258-1390 | |
Advanced Dental Specialists, Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 2600 N Mayfair Rd Ste 101, Wauwatosa, WI 53226 Phone: 414-475-1418 | |
Generations Family Dental Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 2505 N Mayfair Rd, #103, Wauwatosa, WI 53226 Phone: 414-258-2117 Fax: 414-258-4177 | |
Mayfaif Family Dentistry Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 11637 W North Ave, Wauwatosa, WI 53226 Phone: 414-259-0665 |