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Great Lakes Oral & Maxillofacial Surgery, P.a.
Oral and Maxillofacial Surgery (Dentist) in Hudson, Wisconsin
NPI 1902116288

Great Lakes Oral & Maxillofacial Surgery, P.a. is a Oral and Maxillofacial Surgery (Dentist) based in Hudson, WI and is specialized in Oral and Maxillofacial Surgery. Great Lakes Oral & Maxillofacial Surgery, P.a. practices in Hudson, WI. The NPI Number for Great Lakes Oral & Maxillofacial Surgery, P.a. is 1902116288 and holds a License No. 4482 (Wisconsin).

The current practice location address for Great Lakes Oral & Maxillofacial Surgery, P.a. is 1200 Crest View Dr Ste 1, Hudson, WI and can be reached out via phone at 715-381-7070 and via fax at 715-381-0383.

Location: 1200 Crest View Dr Ste 1, Hudson, WI, 54016-9391
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1902116288
Provider Name
Great Lakes Oral & Maxillofacial Surgery, P.a.
Credential
Provider Entity Type
Organization
Address
1200 Crest View Dr Ste 1, Hudson, WI, 54016-9391
Phone Number
715-381-7070
Fax Number
715-381-0383
Provider Enumeration Date
10/20/2010
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
1200 Crest View Dr Ste 1
City
Hudson
State
Wisconsin
Zip
54016-9391
Phone Number
715-381-7070
Fax Number
715-381-0383
person
Provider Business Mailing Address Details
Address
1200 Crest View Dr Ste 1
City
Hudson
State
Wisconsin
Zip
54016-9391
Phone Number
715-381-7070
Fax Number
715-381-0383
person
Provider's Taxonomy Details 1
Type
Dental Providers
Classification
Dentist
Speciality
Oral and Maxillofacial Surgery
Taxonomy
1223S0112X
License No.
4482 (Wisconsin)
Definition
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.
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