Healthcare Provider Details

I. General information

NPI: 1164414355
Provider Name (Legal Business Name): ORAL & MAXILLOFACIAL SURGEONS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 07/21/2022
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 EASTGATE RD SUITE A
TOLEDO OH
43614-3082
US

IV. Provider business mailing address

4646 NANTUCKETT DR STE A
TOLEDO OH
43623-3194
US

V. Phone/Fax

Practice location:
  • Phone: 419-385-5743
  • Fax: 419-385-8835
Mailing address:
  • Phone: 419-517-2100
  • Fax: 419-517-2105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PATRICK J MCCABE
Title or Position: PRESIDENT
Credential: DDS
Phone: 419-517-2100