Organization
PREMIER ORAL & MAXILLOFACIAL SURGERY S.C.
Active
Other names
Southern Wisconsin Oral & Maxillofacial Surgery S.C.
Organization subpart
No
Provider details
NPI number
Authorized official
CRYSTAL M DIETER (MANAGER)
(608) 756-8744
Entity
Organization
Contact information
Practice address
1602 N RANDALL AVE, JANESVILLE, WI 53545-1124
(608) 756-8744
(608) 756-5344
Mailing address
1602 N RANDALL AVE, JANESVILLE, WI 53545-1124
(608) 756-8744
(608) 756-5344
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
5E10250
WI
Other
Enumeration date
09/26/2006
Last updated
06/11/2012
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