Healthcare Provider Details

I. General information

NPI: 1962531178
Provider Name (Legal Business Name): ORAL SURGERY CLINIC OF LA CROSSE LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 05/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2819 NATIONAL DR
ONALASKA WI
54650-6703
US

IV. Provider business mailing address

2819 NATIONAL DR
ONALASKA WI
54650-6703
US

V. Phone/Fax

Practice location:
  • Phone: 608-782-8193
  • Fax: 608-782-4517
Mailing address:
  • Phone: 608-782-8193
  • Fax: 608-782-4517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID PAUL LUDINGTON
Title or Position: OWNER
Credential: D.D.S.
Phone: 608-782-8193