Healthcare Provider Details

I. General information

NPI: 1760699086
Provider Name (Legal Business Name): ORAL AND MAXILLOFACIAL ALLOCATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 08/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 N WEBB RD
WICHITA KS
67206-3405
US

IV. Provider business mailing address

1919 NORTH WEBB ROAD
WICHITA KS
67206-3405
US

V. Phone/Fax

Practice location:
  • Phone: 316-634-1414
  • Fax: 316-634-2907
Mailing address:
  • Phone: 316-634-1414
  • Fax: 316-634-2907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: ROY E COLE
Title or Position: OWNER
Credential: DDS MD
Phone: 316-634-1414