# ORAL FACIAL AND PERIODONTAL SURGERY LLC

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

## Provider details

- **NPI number:** 1144772906
- **Authorized official:** MARY BALLARD DDS (OWNER)
- **Authorized official phone:** (262) 886-0147

## Contact information

- **Practice address:** 13200 GLOBE DR STE 108, MT PLEASANT, WI 53177-1606
- **Practice address phone:** (262) 886-0147
- **Mailing address:** 13200 GLOBE DR STE 108, MT PLEASANT, WI 53177-1606
- **Mailing address phone:** (262) 886-0147
- **Mailing address fax:** (262) 886-0570

## Taxonomy

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

## Other

- **Enumeration date:** 10/27/2016
- **Last updated:** 07/21/2025