Healthcare Provider Details

I. General information

NPI: 1720172992
Provider Name (Legal Business Name): ORAL SURGERY ASSOCIATES OF MILWAUKEE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 NORTH MAYFAIR ROAD SUITE 130
WAUWATOSA WI
53226
US

IV. Provider business mailing address

800 NORTH MAYFAIR ROAD SUITE 130
WAUWATOSA WI
53226
US

V. Phone/Fax

Practice location:
  • Phone: 262-798-0800
  • Fax: 262-798-0851
Mailing address:
  • Phone: 262-798-0800
  • Fax: 262-798-0851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number4130-015
License Number StateWI

VIII. Authorized Official

Name: DR. ALAN A KIMMEL
Title or Position: PRESIDENT
Credential: DDS
Phone: 262-241-0900