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General NPI Number Information
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NPI Number | 1760661789
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Entity Type | Organization
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Legal Business Name | WARREN ORAL AND FACIAL SURGERY, INC.
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Dates
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Enumeration Date | 10/25/2007
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Last Update Date | 10/25/2007
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Provider Practice Location Address
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Address Line | 8893 E MARKET ST
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City | WARREN
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State | OH
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Zip | 44484-2351
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Country | US
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Telephone | 330-856-7950
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Fax | 330-856-1447
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Provider Business Mailing Address
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Address Line | 8893 E MARKET ST
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City | WARREN
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State | OH
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Zip | 44484-2351
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Country | US
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Telephone | 330-856-7950
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Fax | 330-856-1447
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEFFREY RICHARD MCCLAIN
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Credential | D.M.D., M.D.
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Telephone | 330-856-7950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | 35075926
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License Number State | OH
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