# GREAT LAKES ORAL & MAXILLOFACIAL SURGERY, P.A.

> 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:** 1902116288
- **Authorized official:** DR. RICHARD WILLIAM BRUNTON D.D.S. (PRESIDENT)
- **Authorized official phone:** (651) 351-1010

## Contact information

- **Practice address:** 1200 CREST VIEW DR STE 1, HUDSON, WI 54016-9391
- **Practice address phone:** (715) 381-7070
- **Practice address fax:** (715) 381-0383
- **Mailing address:** 1200 CREST VIEW DR STE 1, HUDSON, WI 54016-9391
- **Mailing address phone:** (715) 381-7070
- **Mailing address fax:** (715) 381-0383

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 4482 | WI | Yes |

## Other

- **Enumeration date:** 10/20/2010
- **Last updated:** 10/20/2010