MEDICARE: ORAL SURGERY CENTER, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)		NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598041352
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORAL SURGERY CENTER, P.C.

Provider Business Mailing Address
First Line	:	2501 LAKERIDGE DR
Second Line	:	SUITE 100
City	:	NORFOLK
State	:	NE
Zip	:	68701-2558
Country	:	US
Telephone Number	:	402-644-4452
Fax Number	:	402-644-4454

Provider Business Practice Location Address
First Line	:	2071 33RD AVE
Second Line	:	SUITE B
City	:	COLUMBUS
State	:	NE
Zip	:	68601-3178
Country	:	US
Telephone Number	:	402-562-5557
Fax Number	:	402-562-5553

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. JON DANIEL STINEMAN
Credential	:	D.D.S., M.D.
Telephone Number	:	402-644-4452

Provider Enumeration Date	:	10/25/2011
Last Update Date	:	10/25/2011

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