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General NPI Number Information
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NPI Number | 1154411163
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Entity Type | Organization
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Legal Business Name | ORAL AND MAXILLOFACIAL SURGERY CENTER OF LAFAYETTE
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 02/27/2009
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Provider Practice Location Address
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Address Line | 2020 UNION STREET SUITE 200
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City | LAFAYETTE
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State | IN
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Zip | 47904
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Country | US
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Telephone | 765-446-8808
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Fax | 765-446-9567
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Provider Business Mailing Address
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Address Line | 2020 UNION STREET SUITE 200
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City | LAFAYETTE
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State | IN
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Zip | 47904
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Country | US
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Telephone | 765-446-8808
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Fax | 765-446-9567
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | COURTNEY A JAMES
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Credential |
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Telephone | 765-446-8808
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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 |
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