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General NPI Number Information
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NPI Number | 1861525289
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Entity Type | Organization
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Legal Business Name | ORAL & MAXILLOFACIAL SURGERY FOX CITIES S.C.
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5395 MICHAELS DR
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City | APPLETON
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State | WI
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Zip | 54913-8447
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Country | US
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Telephone | 920-739-1214
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Fax | 920-739-5855
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Provider Business Mailing Address
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Address Line | 5395 MICHAELS DR
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City | APPLETON
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State | WI
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Zip | 54913-8447
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Country | US
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Telephone | 920-739-1214
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Fax | 920-739-5855
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. ANN K DUDLEY
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Credential |
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Telephone | 920-739-1214
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0112X
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Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
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License Number |
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License Number State | WI
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