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General NPI Number Information
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NPI Number | 1679384929
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Entity Type | Organization
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Legal Business Name | TERRE HAUTE ORAL SURGERY LLC
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Dates
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Enumeration Date | 01/16/2025
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 3630 S 4TH ST
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City | TERRE HAUTE
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State | IN
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Zip | 47802-5543
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Country | US
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Telephone | 812-814-9245
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Fax |
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Provider Business Mailing Address
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Address Line | 12651 ROSEBERY ST
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City | CARMEL
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State | IN
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Zip | 46032-7384
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Country | US
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Telephone | 310-689-6148
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Fax |
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Authorized Official
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Title or Position | ORAL SURGEON
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Name | DR. JAN SLAPNICKA
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Credential | MD, DDS
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Telephone | 310-689-6148
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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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