Provider Demographics
NPI:1033389382
Name:ORAL & FACIAL SURGERY FOR ADULTS & CHILDREN LLC
Entity Type:Organization
Organization Name:ORAL & FACIAL SURGERY FOR ADULTS & CHILDREN LLC
Other - Org Name:DAVID A SMELTZER DDS MS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMELTZER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:614-457-9337
Mailing Address - Street 1:1151 BETHEL RD STE 104
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2775
Mailing Address - Country:US
Mailing Address - Phone:614-457-9337
Mailing Address - Fax:614-705-1867
Practice Address - Street 1:1161 BETHEL RD SUITE 303
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2775
Practice Address - Country:US
Practice Address - Phone:614-457-9337
Practice Address - Fax:614-705-1867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300215941223S0112X
OH300202971223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U79415Medicare UPIN
OH9337181Medicare PIN