# ELMBROOK ORAL & MAXILLOFACIAL SURGERY ASSOC., S.C.

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1366586224
- **Authorized official:** ROBERT A. WALLOCK D.D.S. (PRESIDENT)
- **Authorized official phone:** (262) 784-0053

## Contact information

- **Practice address:** 12720 W NORTH AVE, BROOKFIELD, WI 53005-4637
- **Practice address phone:** (262) 784-0053
- **Practice address fax:** (262) 784-0757
- **Mailing address:** 12720 W NORTH AVE, BROOKFIELD, WI 53005-4637
- **Mailing address phone:** (262) 784-0053
- **Mailing address fax:** (262) 784-0757

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 4138-015 | WI | Yes |

## Other

- **Enumeration date:** 02/16/2007
- **Last updated:** 08/22/2020