# COMMUNITY ORAL AND MAXILLOFACIAL SURGERY, LLC

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

## Provider details

- **NPI number:** 1962178970
- **Authorized official:** RUBA KHADER BDS (OWNER)
- **Authorized official phone:** (414) 810-1707

## Contact information

- **Practice address:** 408 W FLORIDA ST STE 105, MILWAUKEE, WI 53204-1509
- **Practice address phone:** (401) 401-4141
- **Mailing address:** 408 W FLORIDA ST STE 105, MILWAUKEE, WI 53204-1509
- **Mailing address phone:** (414) 810-1707

## 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:** 08/19/2021
- **Last updated:** 11/29/2022