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)	6026	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	:	1891096814
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORAL SURGERY CENTER, P.C.

Provider Business Mailing Address
First Line	:	2304 TAYLOR AVE
Second Line	:
City	:	NORFOLK
State	:	NE
Zip	:	68701-4537
Country	:	US
Telephone Number	:	402-644-4452
Fax Number	:	402-644-4454

Provider Business Practice Location Address
First Line	:	2304 TAYLOR AVE
Second Line	:
City	:	NORFOLK
State	:	NE
Zip	:	68701-4537
Country	:	US
Telephone Number	:	402-644-4452
Fax Number	:	402-644-4454

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

Provider Enumeration Date	:	11/08/2010
Last Update Date	:	04/07/2017

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