Healthcare Provider Details

I. General information

NPI: 1447869789
Provider Name (Legal Business Name): OSHKOSH COMPLETE DENTISTRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2020
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 N SAWYER ST
OSHKOSH WI
54902-5674
US

IV. Provider business mailing address

141 N SAWYER ST
OSHKOSH WI
54902-5674
US

V. Phone/Fax

Practice location:
  • Phone: 920-428-5416
  • Fax:
Mailing address:
  • Phone: 920-428-5416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. ROBERT HEIL
Title or Position: PRESIDENT
Credential: DDS
Phone: 920-428-5416