Provider Demographics
NPI:1235466988
Name:ORAL SURGERY ASSOCIATES LTD
Entity type:Organization
Organization Name:ORAL SURGERY ASSOCIATES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:GUY
Authorized Official - Middle Name:K
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:920-923-0111
Mailing Address - Street 1:2100 GATEWAY CT.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-8556
Mailing Address - Country:US
Mailing Address - Phone:262-335-2282
Mailing Address - Fax:262-335-2296
Practice Address - Street 1:2100 GATEWAY CT
Practice Address - Street 2:SUITE 101
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-8550
Practice Address - Country:US
Practice Address - Phone:262-335-2282
Practice Address - Fax:262-335-2296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5001856-151223S0112X
WI5000111-151223S0112X
WI2787-151223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty