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Organization
GREAT LAKES ORAL & MAXILLOFACIAL SURGERY, P.A.
Active
Organization
GREAT LAKES ORAL & MAXILLOFACIAL SURGERY, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CONNIE LOUISE MILLER (PRACTICE MANAGER)
(651) 351-1010
Entity
Organization
Contact information
Practice address
227 MERIDIAN DR # 6, NEW RICHMOND, WI 54017-2565
(715) 246-5150
(715) 246-5102
Mailing address
227 MERIDIAN DR # 6, NEW RICHMOND, WI 54017-2565
(715) 246-5150
(715) 246-5102
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
4482
WI
Other
Enumeration date
10/27/2010
Last updated
10/27/2010
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