Organization
WISCONSIN ORAL & MAXILLOFACIAL SURGERY LLC
Active
Other names
White Oak Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EJLAL ALALAWI DMD (OWNER/PROVIDER)
(914) 325-5672
Entity
Organization
Contact information
Practice address
2603 W RAWSON AVE STE 123, OAK CREEK, WI 53154-8422
(914) 325-5672
Mailing address
124 LEGEND WAY, WALES, WI 53183-9539
(914) 325-5672
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
—
—
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
—
—
Other
Enumeration date
06/05/2018
Last updated
06/05/2018
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