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General NPI Number Information
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NPI Number | 1063549236
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Entity Type | Organization
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Legal Business Name | MILL CREEK ORAL & MAXILLOFACIAL SURGERY ASSOCIATES INC
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 01/23/2012
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Provider Practice Location Address
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Address Line | 5437 MAHONING AVE STE 12
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City | AUSTINTOWN
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State | OH
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Zip | 44515-2421
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Country | US
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Telephone | 330-792-2501
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Fax | 330-792-9249
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Provider Business Mailing Address
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Address Line | 5437 MAHONING AVE SUITE 12
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City | AUSTINTOWN
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State | OH
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Zip | 44515-2437
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Country | US
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Telephone | 330-792-2501
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Fax | 330-792-9249
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK L BILLY
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Credential | D.D.S.
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Telephone | 330-792-2501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | 204E0000X
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License Number State | OH
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