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General NPI Number Information
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NPI Number | 1447736715
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Entity Type | Organization
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Legal Business Name | COLUMBIA ORAL AND MAXILLOFACIAL SERVICES, LLC
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Dates
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Enumeration Date | 07/19/2018
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Last Update Date | 07/19/2018
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Provider Practice Location Address
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Address Line | 1000 W NIFONG BLVD BLDG 4 SUITE 100
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City | COLUMBIA
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State | MO
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Zip | 65201
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Country | US
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Telephone | 573-443-0466
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Fax | 573-442-5417
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Provider Business Mailing Address
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Address Line | 1000 W NIFONG BLVD BLDG 4 SUITE 100
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City | COLUMBIA
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State | MO
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Zip | 65201
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Country | US
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Telephone | 573-443-0466
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Fax | 573-442-5417
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | EVA TRABUE
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Credential |
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Telephone | 573-443-0466
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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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