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General NPI Number Information
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NPI Number | 1013171594
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Entity Type | Organization
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Legal Business Name | CARMEL ORAL & MAXILLOFACIAL SURGERY
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Dates
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Enumeration Date | 07/15/2008
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Last Update Date | 07/15/2008
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Provider Practice Location Address
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Address Line | 13590B N MERIDIAN ST SUITE 105
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City | CARMEL
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State | IN
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Zip | 46032-1456
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Country | US
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Telephone | 317-844-7626
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Fax | 317-844-3804
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Provider Business Mailing Address
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Address Line | 13590B N MERIDIAN ST SUITE 105
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City | CARMEL
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State | IN
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Zip | 46032-1406
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Country | US
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Telephone | 317-844-7626
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Fax | 317-844-3804
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Authorized Official
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Title or Position | PRESIDENT
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Name | STANLEY C. JACHIMOWICZ
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Credential | DDS
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Telephone | 317-844-7626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 12009721A
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License Number State | IN
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