Healthcare Provider Details

I. General information

NPI: 1033384268
Provider Name (Legal Business Name): CENTER FOR ORAL & MAXILLOFACIAL SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 10/06/2021
Certification Date: 10/06/2021
Deactivation Date: 04/24/2018
Reactivation Date: 02/26/2020

III. Provider practice location address

1816 CHAPEL DR SUITE H
FINDLAY OH
45840
US

IV. Provider business mailing address

1816 CHAPEL DR SUITE H
FINDLAY OH
45840-1331
US

V. Phone/Fax

Practice location:
  • Phone: 419-423-4651
  • Fax: 419-423-4320
Mailing address:
  • Phone: 419-423-4651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number21553
License Number StateOH

VIII. Authorized Official

Name: DR. JOHN D ERDELJAC
Title or Position: OWNER
Credential: DDS
Phone: 419-423-4651