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Organization
COMMUNITY ORAL AND MAXILLOFACIAL SURGERY, LLC
Active
Organization
COMMUNITY ORAL AND MAXILLOFACIAL SURGERY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUBA KHADER BDS (OWNER)
(414) 810-1707
Entity
Organization
Contact information
Practice address
408 W FLORIDA ST STE 105, MILWAUKEE, WI 53204-1509
(401) 401-4141
Mailing address
408 W FLORIDA ST STE 105, MILWAUKEE, WI 53204-1509
(414) 810-1707
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
NULL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
08/19/2021
Last updated
11/29/2022
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