# CENTRAL WISCONSIN ORAL AND FACIAL SURGERY, LLC

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

## Provider details

- **NPI number:** 1477065787
- **Authorized official:** PAULETTE WRIGHT (MANAGER)
- **Authorized official phone:** (843) 525-0900

## Contact information

- **Practice address:** 438 EDISON ST, ANTIGO, WI 54409-1845
- **Practice address phone:** (715) 432-4565
- **Mailing address:** 968 RIBAUT RD STE 3, BEAUFORT, SC 29902-8002
- **Mailing address phone:** (843) 525-0900
- **Mailing address fax:** (843) 525-0380

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 5831-15 | WI | Yes |

## Other

- **Enumeration date:** 10/26/2017
- **Last updated:** 10/26/2017