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General NPI Number Information
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NPI Number | 1891973541
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Entity Type | Organization
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Legal Business Name | ELKHART ORAL AND MAXILLOFACIAL SURGERY INC.
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Dates
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Enumeration Date | 02/05/2008
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Last Update Date | 11/15/2017
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Provider Practice Location Address
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Address Line | 117 S NAPPANEE ST
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City | ELKHART
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State | IN
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Zip | 46514-1955
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Country | US
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Telephone | 574-293-8211
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Fax | 574-295-8270
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Provider Business Mailing Address
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Address Line | 117 S NAPPANEE ST
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City | ELKHART
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State | IN
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Zip | 46514-1955
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Country | US
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Telephone | 574-293-8211
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Fax | 574-295-8270
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Authorized Official
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Title or Position | OWNER/PARTNER
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Name | DR. JEFFREY S MCBRIDE
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Credential | DDS
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Telephone | 574-293-8211
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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 | 12008926
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License Number State | IN
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