Provider Demographics
NPI:1447869789
Name:OSHKOSH COMPLETE DENTISTRY LLC
Entity type:Organization
Organization Name:OSHKOSH COMPLETE DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:HEIL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:920-428-5416
Mailing Address - Street 1:623 E TALLGRASS DR
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-7505
Mailing Address - Country:US
Mailing Address - Phone:920-428-5416
Mailing Address - Fax:
Practice Address - Street 1:1013 N MAIN ST
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901-3837
Practice Address - Country:US
Practice Address - Phone:920-428-5416
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-22
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment