Elmbrook Oral & Maxillofacial Surgery Assoc., S.c.
NPI #1366586224 in Brookfield, Wisconsin
Provider Information
- NPI Number
- 1366586224
- Entity Type
- Organization
- Organization Name
- Elmbrook Oral & Maxillofacial Surgery Assoc., S.c.
- Primary Specialty
- Dentist - Oral and Maxillofacial Surgery
- Enumeration Date
- Feb 16, 2007
- Last Updated
- Aug 22, 2020
Practice Location
- Address
- 12720 W NORTH AVE
- City
- Brookfield
- State
- Wisconsin
- ZIP Code
- 53005-4637
- Phone
- (262) 784-0053
Authorized Official
- Name
- ROBERT A. WALLOCK, D.D.S.
- Title
- PRESIDENT
- Phone
- (262) 784-0053
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - Oral and Maxillofacial Surgery — Oral and Maxillofacial Surgery |
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