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General NPI Number Information
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NPI Number | 1336166289
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Entity Type | Organization
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Legal Business Name | CARNES, MONTGOMERY, COOK & HENRY, ORAL & MAX SURG, LLC
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Dates
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Enumeration Date | 07/16/2006
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Last Update Date | 03/13/2012
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Provider Practice Location Address
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Address Line | 6641 N HIGH ST SUITE 105
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City | WORTHINGTON
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State | OH
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Zip | 43085-4038
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Country | US
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Telephone | 614-885-3339
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Fax | 614-885-1011
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Provider Business Mailing Address
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Address Line | 6641 N HIGH ST SUITE 105
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City | WORTHINGTON
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State | OH
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Zip | 43085-4038
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Country | US
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Telephone | 614-885-3339
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Fax | 614-885-1011
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Authorized Official
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Title or Position | INSURANCE COORDINATOR
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Name | MEL T GRASSETTE
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Credential |
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Telephone | 614-885-3339
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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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