Healthcare Provider Details

I. General information

NPI: 1417032889
Provider Name (Legal Business Name): CINCINNATI ORAL & MAXILLOFACIAL SURGERY ASSOC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7140 MIAMI AVE #202
CINCINNATI OH
45243
US

IV. Provider business mailing address

7140 MIAMI AVE
CINCINNATI OH
45243
US

V. Phone/Fax

Practice location:
  • Phone: 513-271-5900
  • Fax: 513-271-5911
Mailing address:
  • Phone: 513-271-5900
  • Fax: 513-271-5911

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: DR. JAMES P CASSIDY
Title or Position: PRESIDENT
Credential: DDS
Phone: 513-271-5900