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General NPI Number Information
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NPI Number | 1043309719
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Entity Type | Organization
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Legal Business Name | COLLEGE PARK ORAL & MAXILLOFACIAL SURGERY
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3677 W 86TH STREET
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City | INDIANAPOLIS
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State | IN
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Zip | 46268-1902
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Country | US
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Telephone | 317-872-7777
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Fax | 317-872-3174
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Provider Business Mailing Address
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Address Line | 3677 W 86TH STREET
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City | INDIANAPOLIS
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State | IN
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Zip | 56268-1902
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Country | US
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Telephone | 317-872-7777
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. J HAROLD SMITH II
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Credential | DDS
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Telephone | 317-872-7777
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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 |
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License Number State | IN
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