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Organization

ELMBROOK ORAL & MAXILLOFACIAL SURGERY ASSOC., S.C.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
ROBERT A. WALLOCK D.D.S. (PRESIDENT)
(262) 784-0053
Entity
Organization

Contact information

Practice address
12720 W NORTH AVE, BROOKFIELD, WI 53005-4637
(262) 784-0053
(262) 784-0757
Mailing address
12720 W NORTH AVE, BROOKFIELD, WI 53005-4637
(262) 784-0053
(262) 784-0757

Taxonomy

Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
4138-015
WI

Other

Enumeration date
02/16/2007
Last updated
08/22/2020
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