OrganizationActive
Great Lakes Oral & Maxillofacial Surgery, P.A.
NPI 1902116288 · Oral and Maxillofacial Surgery (Dentist) · Hudson, WI
Provider details
- NPI number
- 1902116288
- Entity type
- Organization
- Primary specialty
- Oral and Maxillofacial Surgery (Dentist)Dental Providers
- Authorized official
- Richard Brunton, President
- License
- 4482 (WI)
Practice location
1200 Crest View Dr Ste 1
Hudson, WI 54016-9391
Phone: (715) 381-7070
Fax: (715) 381-0383
Mailing address
1200 Crest View Dr Ste 1
Hudson, WI 54016-9391
Registry dates
- Enumerated
- 2010-10-20
- Last updated
- 2010-10-20
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.