Provider Demographics
NPI:1063122976
Name:MIDWEST ORAL & FACIAL SURGERY PLLC
Entity type:Organization
Organization Name:MIDWEST ORAL & FACIAL SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:VOEGELE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:952-452-9151
Mailing Address - Street 1:13875 HWY 13 FRONTAGE RD
Mailing Address - Street 2:STE 50
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378
Mailing Address - Country:US
Mailing Address - Phone:952-452-9151
Mailing Address - Fax:
Practice Address - Street 1:13875 HWY 13 FRONTAGE RD
Practice Address - Street 2:STE 50
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378
Practice Address - Country:US
Practice Address - Phone:952-452-9151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty