Organization
NORTHWOODS ORAL AND MAXILLOFACIAL SURGERY SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN MICHAEL KOSMEN DDS (DENTIST)
(715) 358-3321
Entity
Organization
Contact information
Practice address
9762 WEST LAKE AVENUE, MINOCQUA, WI 54548
(715) 358-3321
Mailing address
PO BOX 1027, MINOCQUA, WI 53548
(715) 358-3321
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
4694
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33727700
—
WI
Enumeration date
04/30/2007
Last updated
09/17/2007
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