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General NPI Number Information
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NPI Number | 1861663106
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Entity Type | Organization
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Legal Business Name | CENTER FOR ORAL AND MAXILLOFACIAL SURGERY
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Dates
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Enumeration Date | 03/14/2008
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Last Update Date | 07/31/2008
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Provider Practice Location Address
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Address Line | 28871 CENTER RIDGE RD SUITE 104
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City | WESTLAKE
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State | OH
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Zip | 44145-5271
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Country | US
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Telephone | 440-871-2201
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Fax | 440-871-2204
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Provider Business Mailing Address
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Address Line | 28871 CENTER RIDGE RD SUITE 104
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City | WESTLAKE
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State | OH
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Zip | 44145-5271
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Country | US
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Telephone | 440-871-2201
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Fax | 440-871-2204
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Authorized Official
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Title or Position | PRESIDENT / OWNER
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Name | DR. THOMAS P MURPHY
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Credential | D.D.S.
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Telephone | 440-871-2201
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0112X
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Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
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License Number | 17516
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License Number State | OH
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