=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720172992
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ORAL SURGERY ASSOCIATES OF MILWAUKEE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2006
-----------------------------------------------------
Last Update Date | 07/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 800 NORTH MAYFAIR ROAD SUITE 130
-----------------------------------------------------
City | WAUWATOSA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-798-0800
-----------------------------------------------------
Fax | 262-798-0851
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 800 NORTH MAYFAIR ROAD SUITE 130
-----------------------------------------------------
City | WAUWATOSA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-798-0800
-----------------------------------------------------
Fax | 262-798-0851
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ALAN A KIMMEL
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 262-241-0900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number | 4130-015
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------