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Lmg INC

Dentist, Oral and Maxillofacial Pathology in Appleton, WI. Organization (NPI-2).

NPI number1063951663
StatusActive
Last updated in NPPESAug 28, 2023

Details

NPI
1063951663
Entity type
Organization (NPI-2)
Legal business name
Lmg INC
Organization subpart
Yes
Enumeration date
Feb 15, 2017
Certification date
Aug 25, 2023
Last updated
Aug 28, 2023

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
1223P0106X Dentist, Oral and Maxillofacial Pathology––Yes

Practice location

W3134 Van Roy Rd
Appleton, WI 54915-3982

Phone 920-882-1710 · Fax 920-882-1708

Mailing address

2626 N 76th St
Suite 105
Wauwatosa, WI 53213-1137

Phone 414-476-9400 · Fax 414-755-4769

Authorized official

Jay L Mackman
Owner-Director
4144769400

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