Unknown Individual – Oral and Maxillofacial Surgery (Dentist), NPI 1023027786

Oral and Maxillofacial Surgery (Dentist)

Unknown Individual is a healthcare provider. based in Altoona, Wisconsin. specializing in Oral and Maxillofacial Surgery (Dentist). They hold a License No. 5563-015 (WI). The NPI Number for Unknown Individual is 1023027786

Main info

Organization

Inactive

25 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1023027786

Phone

(715) 834-8414

Address

788 OAKLEAF WAY

Deactivation Date

31 July 2024

Doctor Profile

Medical School Name

OTHER

Secondary Phone

7158348414

Graduation Year

2001 (25 years ago)

PAC ID

9032116132

Group Practice PAC ID

1456355643

Professional Enrollment ID

I20061102000539

Contacts

Secure Messaging

idozier110258@ewd.direct.hshs.org

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience14

Completeness85

Years active:0State licenses:1Other namesUpdated within 12 months

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Provider Addresses for Unknown Individual

OakLeaf Way, River Prairie Townhomes, Altoona, Eau Claire County, Wisconsin, 54720, United States
ALTOONA, WI 54720
Phone: (715) 834-8414
Fax: (715) 834-8414
Type: Location
1120, Oak Ridge Drive, Upper Campus, Eau Claire, Eau Claire County, Wisconsin, 54701, United States
EAU CLAIRE, WI 547016133
Phone: (715) 834-8414
Fax: (715) 834-8414
Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCS	Description	Services	Beneficiaries	Medicare allowed
99202	New patient office or other outpatient visit, 15-29 minutes	25	25	$0

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Insurance plans in this area (ZIP 54720)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.

PAC ID: 1456355643View full group profile

Name	Specialty	State
DR. M. DREW MILLINGTON (D.D.S.)	Oral Surgery	WI
DR. JEFF GOETZ (D.D.S.)	-	WI
WILLIAM ARTHUR GROSDIDIER	Oral Surgery	AP
STEPHEN J RIDENOUR (DDS)	-	WI
DR. SLAVKO IVANKOVIC (D.D.S.)	Oral Surgery	WI

Reviews

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Frequently asked questions

What is the 10-digit NPI for Unknown Individual?

Unknown Individual — NPI 1023027786 — is the standard way to identify this listing.

Why is Unknown Individual marked inactive in the NPI directory?

The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.

What is Unknown Individual best known for clinically?

Directory data describes Unknown Individual with Oral and Maxillofacial Surgery (Dentist). Clinical services aligned with this taxonomy classification.

What address line appears for Unknown Individual?

Unknown Individual's geographic hint is Altoona, Wisconsin in our summary view.

How many locations tie to this NPI?

2 practice locations appear in the available data.