# CENTER FOR ORAL & MAXILLOFACIAL SURGERY SC

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

## Provider details

- **NPI number:** 1710900808
- **Authorized official:** GARY W. SWEENEY DDS (S CORP PRESIDENT)
- **Authorized official phone:** (608) 833-2060

## Contact information

- **Practice address:** 7007 OLD SAUK RD, MADISON, WI 53713
- **Practice address phone:** (608) 833-2060
- **Practice address fax:** (608) 833-1737
- **Mailing address:** 20 S PARK ST \#506, MADISON, WI 53715
- **Mailing address phone:** (608) 256-1961
- **Mailing address fax:** (608) 256-1501

## 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:** 07/26/2006
- **Last updated:** 08/22/2020