Organization
APPLE CREEK ORAL SURGERY, SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY J KOLL (PRESIDENT)
(920) 832-9500
Entity
Organization
Contact information
Practice address
2410 EAST EVERGREEN DRIVE, APPLETON, WI 54913
(920) 832-9500
Mailing address
2410 E. EVERGREEN DRIVE, APPLETON, WI 54913
(920) 832-9500
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
Primary
4243
WI
Other
Enumeration date
04/26/2007
Last updated
08/22/2020
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