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Kenosha Oral Surgery, S.c. — NPI 1710160486, Kenosha, WI | NPI Central

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NPI 1710160486

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Kenosha Oral Surgery, S.c.

NPI 1710160486 · Oral and Maxillofacial Surgery (Dentist) · Kenosha, WI

Provider details

NPI number: 1710160486
Entity type: Organization
Primary specialty: Oral and Maxillofacial Surgery (Dentist)Dental Providers
Authorized official: Dale Willoughby, President
License: 4998015 (WI)

Practice location

6707 39th Ave

Kenosha, WI 53142-7125

Phone: (262) 658-3559

Fax: (262) 658-0276

More WI providers

Mailing address

4707 Washington Rd

Kenosha, WI 53144-1597

Registry dates

Enumerated: 2007-12-17
Last updated: 2022-06-02

Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.