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General NPI Number Information
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NPI Number | 1144261199
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Entity Type | Organization
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Legal Business Name | MADISON ORAL & MAXILLOFACIAL SURGEONS SC
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Dates
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Enumeration Date | 06/09/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5801 RESEARCH PARK BLVD STE 110
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City | MADISON
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State | WI
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Zip | 53719-6002
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Country | US
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Telephone | 608-274-7711
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Fax | 608-274-9224
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Provider Business Mailing Address
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Address Line | 5801 RESEARCH PARK BLVD STE 110
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City | MADISON
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State | WI
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Zip | 53719-6002
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Country | US
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Telephone | 608-274-7711
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Fax | 608-274-9224
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Authorized Official
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Title or Position | TREASURER
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Name | GREGORY G STRONCEK
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Credential | DDS
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Telephone | 608-274-0770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State | WI
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