Organization
WISCONSIN ORAL SURGERY LLC
Active
Parent organization
ADVANCED DENTAL SPECIALISTS, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
ADVANCED DENTAL SPECIALISTS, LLC
Authorized official
DR. ROBERT TRETTIN DDS (PRESIDENT)
(414) 357-2040
Entity
Organization
Contact information
Practice address
10401 W LINCOLN AVE STE 101, WEST ALLIS, WI 53227-1255
(414) 327-4130
Mailing address
401 EDGEWATER PL STE 430, WAKEFIELD, MA 01880-6225
(781) 213-0240
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223P0106X
Oral and Maxillofacial Pathology Dentistry
Primary
—
—
1223P0700X
Prosthodontics
—
—
Other
Enumeration date
06/11/2019
Last updated
06/11/2019
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