MEDICARE: ORAL SURGERY CENTER OF ELKHART, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	12007801	IN

General Provider Information

NPI Number	:	1750610333
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORAL SURGERY CENTER OF ELKHART, INC

Provider Business Mailing Address
First Line	:	232 WATERFALL DR
Second Line	:
City	:	ELKHART
State	:	IN
Zip	:	46516-3668
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	232 WATERFALL DR
Second Line	:
City	:	ELKHART
State	:	IN
Zip	:	46516-3668
Country	:	US
Telephone Number	:	574-532-3085
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT / OWNER
Name	:	SCOTT D HEWITT
Credential	:	D.D.S.
Telephone Number	:	574-532-3085

Provider Enumeration Date	:	12/10/2009
Last Update Date	:	12/10/2009

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