# ORAL & MAXILLOFACIAL SURGERY CONSULTANTS OF WISCONSIN, S.C.

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

## Provider details

- **NPI number:** 1285649921
- **Authorized official:** DR. RONALD HENRY NELLEN DDS (PRESIDENT)
- **Authorized official phone:** (414) 281-3344

## Contact information

- **Practice address:** 4811 S 76TH ST, SUITE 304, GREENFIELD, WI 53220-4364
- **Practice address phone:** (414) 281-3344
- **Practice address fax:** (414) 281-1080
- **Mailing address:** 4811 S 76TH ST, SUITE 304, GREENFIELD, WI 53220-4364
- **Mailing address phone:** (414) 281-3344
- **Mailing address fax:** (414) 281-1080

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 2699 | WI | Yes |

## Other

- **Enumeration date:** 07/30/2006
- **Last updated:** 08/22/2020