Organization
ORAL AND MAXILLOFACIAL SURGERY ASSO OF EAU CLAIRE SC
Active
Other names
Oral and Maxillofacial Surgery Associates of Eau Claire SC
Organization subpart
No
Provider details
NPI number
Authorized official
GINA K THOR (TRANSCRIPTION AND CREDENTIALING)
(715) 834-8414
Entity
Organization
Contact information
Practice address
788 OAKLEAF WAY, ALTOONA, WI 54720
(715) 834-8414
(715) 834-3557
Mailing address
1120 OAK RIDGE DRIVE, EAU CLAIRE, WI 54701
(715) 834-8414
(715) 834-3557
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
4412-015
WI
1223E0200X
Endodontics
6222-15
WI
1223E0200X
Endodontics
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
4495-015
WI
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
4680-015
WI
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
5112-015
WI
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
5563-015
WI
Other
Enumeration date
08/03/2006
Last updated
07/26/2018
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