KENOSHA ORAL SURGERY, S.C.
NPI 1710160486
Dentist - Oral and Maxillofacial Surgery in Kenosha, WI

Q: What is Kenosha Oral Surgery, S.C.'s NPI number?

The NPI number for Kenosha Oral Surgery, S.C. is 1710160486. It was assigned to this organization in the NPPES registry on December 17, 2007.

Q: What is Kenosha Oral Surgery, S.C.'s specialty?

The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Surgery, with taxonomy code 1223S0112X.

Active since December 17, 2007

6707 39TH AVE, KENOSHA, WI 53142(262) 658-3559(262) 658-0276 Get Directions Write a Review

NPPES record last updated: June 2, 2022. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Kenosha Oral Surgery, S.c. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KENOSHA ORAL SURGERY, S.C. (NPI 1710160486) is a healthcare organization registered as an oral and maxillofacial surgery in Kenosha, Wisconsin and active in the NPI registry since December 2007. The organization lists Dale Willoughby, President, as its authorized official.

NPPES Registry Identity

NPI1710160486

Entity TypeOrganization

Primary Taxonomy1223S0112X

Legal Business NameKENOSHA ORAL SURGERY, S.C.

Location Address6707 39TH AVEKenosha, WI 53142-7125

Mailing Address4707 Washington RdKenosha, WI 53144-1597 · (262) 658-3559 · Fax (262) 658-0276

Phone(262) 658-3559

Fax(262) 658-0276

Organization SubpartNo

Authorized OfficialDale WilloughbyPresident · (262) 658-3559

Enumeration DateDecember 17, 2007

Last NPPES UpdateJune 2, 2022

NPPES CertifiedJune 2, 2022

✔ NPI 1710160486 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Oral and Maxillofacial SurgeryDental Providers

Taxonomy Code1223S0112X

License✔ Licensed in WI · 4998015

Definition

An oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.

6707 39TH AVE, Kenosha, WI 53142

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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DALE WAYNE WILLOUGHBY DDS

Dentist (Oral and Maxillofacial Surgery)

6707 39TH AVE
KENOSHA, WI 53142

Kenosha County (262) 658-3559

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kenosha Oral Surgery, S.C.'s NPI number?

The NPI number for Kenosha Oral Surgery, S.C. is 1710160486. It was assigned to this organization in the NPPES registry on December 17, 2007.

Where is Kenosha Oral Surgery, S.C. located?

Kenosha Oral Surgery, S.C. is located at 6707 39th Ave, Kenosha, WI 53142. The listed phone number is (262) 658-3559.

What is Kenosha Oral Surgery, S.C.'s specialty?

The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Surgery, with taxonomy code 1223S0112X.

When was this NPI record last updated?

The NPPES record for Kenosha Oral Surgery, S.C. was last updated on June 2, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.