OrganizationActive
Area Oms
NPI 1306615380 · Oral and Maxillofacial Surgery (Dentist) · Beaver Dam, WI
Provider details
- NPI number
- 1306615380
- Entity type
- Organization
- Primary specialty
- Oral and Maxillofacial Surgery (Dentist)Dental Providers
- Organization subpart
- No
- Authorized official
- Jarrod Thomas, President(920) 261-0495
Specialties & taxonomies
Dental Providers
Practice location
301 S Roosevelt Dr
Beaver Dam, WI 53916-2439
Phone: (920) 365-9711
Approximate (ZIP-level) locationGet directions
Mailing address
301 S Roosevelt Dr
Beaver Dam, WI 53916-2439
Registry dates
- Enumerated
- 2024-01-01
- Last updated
- 2024-01-01
- Certified
- 2024-01-01
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.