WISCONSIN ORAL MEDICINE LLC NPI 1417740465

NPI Information

  • NPI: 1417740465
  • Provider Name: WISCONSIN ORAL MEDICINE LLC
  • Classification: Dentist - 1223S0112X
  • Specialization: Oral and Maxillofacial Surgery
  • Entity Type: Organization
  • Address: 8405 W FOREST HOME AVE
    GREENFIELD, WI
    ZIP 53228
  • Phone: (443) 255-8743

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NPI Details

WISCONSIN ORAL MEDICINE LLC is an oral and maxillofacial surgery dentist in Greenfield, WI. The provider is an oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. WISCONSIN ORAL MEDICINE LLC NPI is 1417740465. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

8405 W FOREST HOME AVE
GREENFIELD, WI
ZIP 53228-407
Phone: (443) 255-8743

The provider's authorized official is Bhavik Desai .
The authorized official title is Owner and has the following contact phone number (443) 255-8743.

The enumeration date for this NPI number is 5/23/2025 and was last updated on 5/23/2025.

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
11223S0112XDentistOral and Maxillofacial SurgeryYes

What is NPI?

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This page was last updated on: 3/30/2025

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