Organization
SHEBOYGAN ORAL AND MAXILLOFACIAL ASSOC LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN JAY KELLER DDS (PRESIDENT)
(920) 458-8213
Entity
Organization
Contact information
Practice address
.3637 WILGUS AVENUE, SHEBOYGAN, WI 53081
(920) 458-8213
(920) 459-9797
Mailing address
3637 WILGUS AVENUE, SHEBOYGAN, WI 53081
(920) 458-8213
(920) 459-9797
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38365300
—
WI
Enumeration date
05/04/2006
Last updated
01/21/2009
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