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General NPI Number Information
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NPI Number | 1265479737
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Entity Type | Organization
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Legal Business Name | AVON ORAL & MAXILLOFACIAL SURGERY LLP
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Dates
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Enumeration Date | 06/01/2006
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Last Update Date | 08/20/2013
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Provider Practice Location Address
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Address Line | 6695 E US HIGHWAY 36
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City | AVON
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State | IN
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Zip | 46123-8923
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Country | US
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Telephone | 317-272-2200
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Fax | 317-272-3714
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Provider Business Mailing Address
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Address Line | 6695 E US HIGHWAY 36
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City | AVON
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State | IN
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Zip | 46123-8923
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Country | US
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Telephone | 317-272-2200
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Fax | 317-272-3714
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KIM KINGERY
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Credential |
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Telephone | 317-272-2200
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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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