Organization
OCONOMOWOC DENTAL ANESTHESIA CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HENRY HOPKINSON (EXECUTIVE DIRECTOR)
(321) 514-4992
Entity
Organization
Contact information
Practice address
888 THACKERAY TRL STE 214, OCONOMOWOC, WI 53066-4342
(262) 567-9116
Mailing address
888 THACKERAY TRL STE 214, OCONOMOWOC, WI 53066-4342
(262) 567-9116
Taxonomy
Speciality
Code
Description
License number
State
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
—
—
Other
Enumeration date
06/25/2019
Last updated
06/25/2019
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