Healthcare Provider Details

I. General information

NPI: 1013266295
Provider Name (Legal Business Name): NEW ALBANY JAW AND FACIAL SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2012
Last Update Date: 09/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5101 FOREST DR SUITE B
NEW ALBANY OH
43054-8215
US

IV. Provider business mailing address

1575 CROSS CREEKS BLVD
PICKERINGTON OH
43147-8237
US

V. Phone/Fax

Practice location:
  • Phone: 614-751-7500
  • Fax: 614-322-7900
Mailing address:
  • Phone: 614-751-7500
  • Fax: 614-322-7900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number20162
License Number StateOH

VIII. Authorized Official

Name: AMY R COLLINS
Title or Position: BILLING OFFICE COORDINATOR
Credential:
Phone: 614-751-7500