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General NPI Number Information
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NPI Number | 1982696175
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Entity Type | Organization
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Legal Business Name | ORAL & MAXILLOFACIAL SURGEONS INC
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Dates
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Enumeration Date | 08/16/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 970 W WOOSTER ST SUITE 126
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City | BOWLING GREEN
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State | OH
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Zip | 43402-2643
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Country | US
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Telephone | 419-353-2100
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Fax | 419-353-6606
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Provider Business Mailing Address
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Address Line | 4646 NANTUCKETT DR STE A
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City | TOLEDO
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State | OH
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Zip | 43623-3194
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Country | US
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Telephone | 419-517-2100
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Fax | 419-517-2105
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Authorized Official
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Title or Position | PRESIDENT
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Name | PATRICK J MCCABE
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Credential | DDS
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Telephone | 419-517-2100
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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 | OH
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