ORAL SURGERY ASSOC LTD NPI 1013020866

NPI Information

  • NPI: 1013020866
  • Provider Name: ORAL SURGERY ASSOC LTD
  • Classification: Oral & Maxillofacial Surgery - 204E00000X
  • Entity Type: Organization
  • Address: 464 SOUTH HICKORY STREET
    SUITE A
    FOND DU LAC, WI
    ZIP 54935
  • Phone: (920) 923-0111

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NPI Details

ORAL SURGERY ASSOC LTD is an oral maxillofacial surgery in Fond Du Lac, WI. The provider is oral and maxillofacial surgeons are trained to recognize and treat a wide spectrum of diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region. They are also trained to administer anesthesia, and provide care in an office setting. They are trained to treat problems such as the extraction of wisdom teeth, misaligned jaws, tumors and cysts of the jaw and mouth, and to perform dental implant surgery. ORAL SURGERY ASSOC LTD NPI is 1013020866. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

464 SOUTH HICKORY STREET
SUITE A
FOND DU LAC, WI
ZIP 54935
Phone: (920) 923-0111
Fax: (920) 923-0366

The provider's authorized official is Guy K Jensen .
The authorized official title is Owner and has the following contact phone number (920) 923-0111.

The enumeration date for this NPI number is 8/16/2006 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1204E00000XOral & Maxillofacial Surgery5001856-015WISCONSINNo
2204E00000XOral & Maxillofacial Surgery5000111-015WISCONSINYes

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This page was last updated on: 11/21/2025

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