Organization
GREAT LAKES ORAL & MAXILLOFACIAL SURGERY, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD WILLIAM BRUNTON D.D.S. (PRESIDENT)
(651) 351-1010
Entity
Organization
Contact information
Practice address
1200 CREST VIEW DR STE 1, HUDSON, WI 54016-9391
(715) 381-7070
(715) 381-0383
Mailing address
1200 CREST VIEW DR STE 1, HUDSON, WI 54016-9391
(715) 381-7070
(715) 381-0383
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
4482
WI
Other
Enumeration date
10/20/2010
Last updated
10/20/2010
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