GREAT LAKES ORAL & MAXILLOFACIAL SURGERY, P.A.
NPI 1902116288
Dentist - Oral and Maxillofacial Surgery in Hudson, WI

Q: What is Great Lakes Oral & Maxillofacial Surgery, P.A.'s specialty?

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

Active since October 20, 2010

1200 CREST VIEW DR STE 1, HUDSON, WI 54016(715) 381-7070(715) 381-0383 Get Directions Write a Review

NPPES record last updated: October 20, 2010. Verified against the NPPES registry weekly; last sync: August 23, 2026.

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About Great Lakes Oral & Maxillofacial Surgery, P.a. NPPES

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

GREAT LAKES ORAL & MAXILLOFACIAL SURGERY, P.A. (NPI 1902116288) is a healthcare organization registered as an oral and maxillofacial surgery in Hudson, Wisconsin and active in the NPI registry since October 2010. The organization lists Richard William Brunton, President, as its authorized official.

NPPES Registry Identity

NPI1902116288

Entity TypeOrganization

Primary Taxonomy1223S0112X

Legal Business NameGREAT LAKES ORAL & MAXILLOFACIAL SURGERY, P.A.

Location Address1200 CREST VIEW DR STE 1Hudson, WI 54016-9391

Mailing Address1200 Crest View Dr Ste 1Hudson, WI 54016-9391 · (715) 381-7070 · Fax (715) 381-0383

Phone(715) 381-7070

Fax(715) 381-0383

Organization SubpartNo

Authorized OfficialRichard William BruntonPresident · (651) 351-1010

Enumeration DateOctober 20, 2010

✔ NPI 1902116288 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 · 4482

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.

1200 CREST VIEW DR STE 1, Hudson, WI 54016

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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

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 Great Lakes Oral & Maxillofacial Surgery, P.A.'s NPI number?

The NPI number for Great Lakes Oral & Maxillofacial Surgery, P.A. is 1902116288. It was assigned to this organization in the NPPES registry on October 20, 2010.

Where is Great Lakes Oral & Maxillofacial Surgery, P.A. located?

Great Lakes Oral & Maxillofacial Surgery, P.A. is located at 1200 Crest View Dr Ste 1, Hudson, WI 54016. The listed phone number is (715) 381-7070.

What is Great Lakes Oral & Maxillofacial Surgery, P.A.'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 Great Lakes Oral & Maxillofacial Surgery, P.A. was last updated on October 20, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 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.