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Organization
CENTRAL WISCONSIN ORAL AND FACIAL SURGERY, LLC
Active
Organization
CENTRAL WISCONSIN ORAL AND FACIAL SURGERY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAULETTE WRIGHT (MANAGER)
(843) 525-0900
Entity
Organization
Contact information
Practice address
438 EDISON ST, ANTIGO, WI 54409-1845
(715) 432-4565
Mailing address
968 RIBAUT RD STE 3, BEAUFORT, SC 29902-8002
(843) 525-0900
(843) 525-0380
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
5831-15
WI
Other
Enumeration date
10/26/2017
Last updated
10/26/2017
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