MEDICARE: ORAL SURGERY OFFICE LLC

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)		IN

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	:	1881696847
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORAL SURGERY OFFICE LLC

Provider Business Mailing Address
First Line	:	2204 SCOTT ST
Second Line	:
City	:	LAFAYETTE
State	:	IN
Zip	:	47904-2933
Country	:	US
Telephone Number	:	765-447-0525
Fax Number	:	765-447-5815

Provider Business Practice Location Address
First Line	:	2204 SCOTT ST
Second Line	:
City	:	LAFAYETTE
State	:	IN
Zip	:	47904-2933
Country	:	US
Telephone Number	:	765-447-0525
Fax Number	:	765-447-5815

Authorized Official
Title or Position	:	CO-OWNER
Name	:	DR. DAVID BRIAN COATES
Credential	:	D.D.S.
Telephone Number	:	765-447-0525

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	07/21/2022

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Directions to “ORAL SURGERY OFFICE LLC ” Practice Location

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