# LAKE GENEVA ORAL AND MAXILLOFACIAL SURGERY, LTD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063420206
- **Authorized official:** ADAM OZMENT D.D.S. (PRESIDENT)
- **Authorized official phone:** (262) 248-8766

## Contact information

- **Practice address:** 312 CENTER ST, LAKE GENEVA, WI 53147-1904
- **Practice address phone:** (262) 248-8766
- **Practice address fax:** (262) 248-6790
- **Mailing address:** 312 CENTER ST, LAKE GENEVA, WI 53147-1904
- **Mailing address phone:** (262) 248-8766
- **Mailing address fax:** (262) 248-6790

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | WI | Yes |

## Other

- **Enumeration date:** 08/03/2006
- **Last updated:** 07/21/2022