# WISCONSIN ORAL MEDICINE LLC

> 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:** 1417740465
- **Authorized official:** BHAVIK DESAI MD (OWNER)
- **Authorized official phone:** (443) 255-8743

## Contact information

- **Practice address:** 8405 W FOREST HOME AVE, GREENFIELD, WI 53228-3407
- **Practice address phone:** (443) 255-8743
- **Mailing address:** 6400 INDUSTRIAL LOOP, GREENDALE, WI 53129-2452
- **Mailing address phone:** (414) 858-4125
- **Mailing address fax:** (414) 423-4134

## 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:** 05/23/2025
- **Last updated:** 05/23/2025