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Organization
WISCONSIN ORAL MEDICINE LLC
Active
Organization
WISCONSIN ORAL MEDICINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BHAVIK DESAI MD (OWNER)
(443) 255-8743
Entity
Organization
Contact information
Practice address
8405 W FOREST HOME AVE, GREENFIELD, WI 53228-3407
(443) 255-8743
Mailing address
6400 INDUSTRIAL LOOP, GREENDALE, WI 53129-2452
(414) 858-4125
(414) 423-4134
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
NULL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
05/23/2025
Last updated
05/23/2025
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