Healthcare Provider Details

I. General information

NPI: 1306340567
Provider Name (Legal Business Name): OAKWOOD ORAL AND MAXILLOFACIAL SURGERY, CHRISTOPHER N. BEALE, DDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2018
Last Update Date: 03/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 LEXINGTON AVE
MANSFIELD OH
44907-1500
US

IV. Provider business mailing address

630 LEXINGTON AVE
MANSFIELD OH
44907-1500
US

V. Phone/Fax

Practice location:
  • Phone: 419-756-0711
  • Fax: 419-756-4886
Mailing address:
  • Phone: 419-756-0711
  • Fax: 419-756-4886

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: RANDI BITTLE
Title or Position: OFFICE MANAGER
Credential:
Phone: 419-756-0711