Healthcare Provider Details

I. General information

NPI: 1861663106
Provider Name (Legal Business Name): CENTER FOR ORAL AND MAXILLOFACIAL SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2008
Last Update Date: 07/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28871 CENTER RIDGE RD SUITE 104
WESTLAKE OH
44145-5271
US

IV. Provider business mailing address

28871 CENTER RIDGE RD SUITE 104
WESTLAKE OH
44145-5271
US

V. Phone/Fax

Practice location:
  • Phone: 440-871-2201
  • Fax: 440-871-2204
Mailing address:
  • Phone: 440-871-2201
  • Fax: 440-871-2204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number17516
License Number StateOH

VIII. Authorized Official

Name: DR. THOMAS P MURPHY
Title or Position: PRESIDENT / OWNER
Credential: D.D.S.
Phone: 440-871-2201