GREAT LAKES ORAL & MAXILLOFACIAL SURGERY, P.A. (NPI# 1205136074) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205136074 |
| Entity Type | Organization |
| Organization Name | GREAT LAKES ORAL & MAXILLOFACIAL SURGERY, P.A. |
| Practice Address |
227 Meridian Dr # 6 New Richmond WI 54017-2565 |
| Practice Telephone | 7152465150 |
| Practice Fax Number | 7152465102 |
| Mailing Telephone | 7152465150 |
| Mailing Fax Number | 7152465102 |
| Enumeration Date | 2010-10-27 |
| Last Update Date | 2010-10-27 |
| Authorized Official Name | MRS. CONNIE LOUISE MILLER (PRACTICE MANAGER) |
| Authorized Official Telephone | 6513511010 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
4482 | WI | Dental Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902116288 | Great Lakes Oral & Maxillofacial Surgery, P.a. | Dentist | 1200 Crest View Dr Ste 1, Hudson, WI 54016-9391 | 2010-10-20 |
| 1508058322 | Great Lakes Oral & Maxillofacial Surgery, P.a. | Dentist | 2850 Curve Crest Blvd, Suite 130, Stillwater, MN 55082 | 2007-08-15 |
| Street Address |
227 MERIDIAN DR # 6 |
| City | NEW RICHMOND |
| State | WI |
| Zip Code | 54017-2565 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871105619 | Matthew Michael Richard Kobriger | Marriage & Family Therapist | 1477 S Knowles Ave Suite 120, New Richmond, WI 54017 | 2020-08-22 |
| 1285148643 | River Valley Anesthesia, Inc. | Nurse Anesthetist, Certified Registered | 130 S. Knowles Ave., New Richmond, WI 54017 | 2017-11-21 |
| 1013351899 | Deerfield Care Cener, LLC | Clinic/Center | 575 Hospital Road, New Richmond, WI 54017 | 2013-04-23 |
| 1215239736 | Family Therapy Associates, LLC | Clinic/Center | 150 W. First St., Suite 270, New Richmond, WI 54017 | 2010-12-04 |
| 1255452215 | Joseph Scott Gustafson Sr. | Acupuncturist | 1475 Hwy 65, Pain Management Acupuncture of St Croix, New Richmond, WI 54017 | 2007-04-03 |
| 1467582957 | New Richmond Dental | Dentist | 1367 Campus Dr, New Richmond, WI 54017 | 2007-03-06 |
| 1588709513 | Holly Wolf | Occupational Therapist | 908 Brady Lane, New Richmond, WI 54017 | 2007-02-20 |
| 1396891867 | Jamie Marie Neumann | Physical Therapy Assistant | 535 Hospital Rd., New Richmond, WI 54017 | 2007-01-26 |
| 1467519660 | New Richmond Chiropractic Clinic Inc | Chiropractor | 446 S Knowles Ave, New Richmond, WI 54017 | 2007-01-03 |
| 1750457156 | Susan Ann Johnson | Chiropractor | 446 S. Knowles Ave, New Richmond, WI 54017 | 2006-11-28 |
| Find all providers in zip 54017 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114143534 | Regan Frederick Brown | Dentist | 227 Meridian Dr, Suite 3, New Richmond, WI 54017-2565 | 2007-04-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720569783 | Greater Milwaukee Oral Surgery, L.L.C. | Dentist | 4811 S 76th St Ste 304, Greenfield, WI 53220-4350 | 2018-08-27 |
| 1124516893 | Baycare Clinic, LLP | Dentist | 636 N 12th Ave, Sturgeon Bay, WI 54235-1249 | 2018-04-27 |
| 1477065787 | Central Wisconsin Oral and Facial Surgery, LLC | Dentist | 438 Edison St, Antigo, WI 54409-1845 | 2017-10-26 |
| 1497266910 | Donald Ervin Linneman | Dentist | Center 4820 N Sherman Road, Winnebago Correction Center, Drug Abuse Correctional, Winnebago, WI 54985-0036 | 2017-10-24 |
| 1063869485 | Tyler Kalmuck | Dentist | 3637 Wilgus Ave, Sheboygan, WI 53081-3050 | 2016-05-16 |
| 1952717753 | Judson Charles Smith | Dentist | 2323 N Mayfair Rd Ste 102, Milwaukee, WI 53226 | 2014-07-01 |
| 1073930459 | Paul Pamula | Dentist | 1925 S Green Bay Rd, Mount Pleasant, WI 53406-4654 | 2014-03-24 |
| 1326473927 | Lake Geneva Dental Care, LLC | Dentist | 1454 E Huebbe Pkwy, Beloit, WI 53511-1714 | 2013-09-13 |
| 1093154601 | Matthew D Reiland | Dentist | 2921 Landmark Pl Ste 100, Madison, WI 53713-4248 | 2013-06-17 |
| 1922364363 | Ell Louis Lee | Dentist | 2361 Lost Dauphin Rd, De Pere, WI 54115-9165 | 2012-04-10 |
| Find all providers with the same taxonomy | ||||
| City | NEW RICHMOND |
| Zip Code | 54017 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.