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General NPI Number Information
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NPI Number | 1417740465
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Entity Type | Organization
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Legal Business Name | WISCONSIN ORAL MEDICINE LLC
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Dates
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Enumeration Date | 05/23/2025
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Last Update Date | 05/23/2025
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Provider Practice Location Address
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Address Line | 8405 W FOREST HOME AVE
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City | GREENFIELD
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State | WI
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Zip | 53228-3407
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Country | US
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Telephone | 443-255-8743
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Fax |
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Provider Business Mailing Address
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Address Line | 6400 INDUSTRIAL LOOP
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City | GREENDALE
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State | WI
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Zip | 53129-2452
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Country | US
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Telephone | 414-858-4125
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Fax | 414-423-4134
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Authorized Official
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Title or Position | OWNER
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Name | BHAVIK DESAI
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Credential | MD
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Telephone | 443-255-8743
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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 |
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