MEDICARE: MADISON ORAL & MAXILLOFACIAL SURGEONS SC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)		WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	407050	OTHER	WI	DEAN HEALTH PLAN GROUP

General Provider Information

NPI Number	:	1144261199
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MADISON ORAL & MAXILLOFACIAL SURGEONS SC

Provider Business Mailing Address
First Line	:	5801 RESEARCH PARK BLVD
Second Line	:	STE 110
City	:	MADISON
State	:	WI
Zip	:	53719-6002
Country	:	US
Telephone Number	:	608-274-7711
Fax Number	:	608-274-9224

Provider Business Practice Location Address
First Line	:	5801 RESEARCH PARK BLVD
Second Line	:	STE 110
City	:	MADISON
State	:	WI
Zip	:	53719-6002
Country	:	US
Telephone Number	:	608-274-7711
Fax Number	:	608-274-9224

Authorized Official
Title or Position	:	TREASURER
Name	:	GREGORY G STRONCEK
Credential	:	DDS
Telephone Number	:	608-274-0770

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	08/22/2020

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Directions to “MADISON ORAL & MAXILLOFACIAL SURGEONS SC ” Practice Location

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