# SHEBOYGAN ORAL AND MAXILLOFACIAL ASSOC LTD

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

## Provider details

- **NPI number:** 1306894134
- **Authorized official:** DR. JOHN JAY KELLER DDS (PRESIDENT)
- **Authorized official phone:** (920) 458-8213

## Contact information

- **Practice address:** .3637 WILGUS AVENUE, SHEBOYGAN, WI 53081
- **Practice address phone:** (920) 458-8213
- **Practice address fax:** (920) 459-9797
- **Mailing address:** 3637 WILGUS AVENUE, SHEBOYGAN, WI 53081
- **Mailing address phone:** (920) 458-8213
- **Mailing address fax:** (920) 459-9797

## 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:** 05/04/2006
- **Last updated:** 01/21/2009