Healthcare Provider Details

I. General information

NPI: 1245374362
Provider Name (Legal Business Name): ORAL SURGERY CENTER, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 8TH ST
BARABOO WI
53913-1805
US

IV. Provider business mailing address

1203 8TH ST
BARABOO WI
53913-1805
US

V. Phone/Fax

Practice location:
  • Phone: 608-356-2112
  • Fax: 608-356-0919
Mailing address:
  • Phone: 608-356-2112
  • Fax: 608-356-0919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. ERICH HERBST
Title or Position: PRESIDENT
Credential: DDS
Phone: 608-356-2112