Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Great Lakes Oral & Maxillofacial Surgery, PA

Organization Oral and Maxillofacial Surgery (Dentist) · NPI 1205136074

Great Lakes Oral & Maxillofacial Surgery, PA is an Oral and Maxillofacial Surgery (Dentist) in New Richmond, Wisconsin. Licensed in Wisconsin. Registered with an NPI since 2010.

Licensed in
WI
In the registry since
2010
What do these letters mean?
PA — Professional association
A form of business registration, not a clinical qualification.

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Practice location Address checks out

227 Meridian Dr # 6
New Richmond, WI 54017-2565
Phone: (715) 246-5150
Fax: (715) 246-5102
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Oral and Maxillofacial Surgery (Dentist) (primary) Taxonomy 1223S0112X · Licence 4482 (WI)

Record details

NPI number1205136074
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Connie Miller — Practice Manager · (651) 351-1010
NPI enumeratedOctober 27, 2010
Last updated in NPPESOctober 27, 2010
Mailing address227 Meridian Dr # 6, New Richmond, WI 54017-2565

Other providers in New Richmond