Provider Demographics
NPI:1043254246
Name:ORAL & MAXILLOFACIAL SURGERY CENTERS, INC.
Entity Type:Organization
Organization Name:ORAL & MAXILLOFACIAL SURGERY CENTERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-477-8544
Mailing Address - Street 1:24561 ST RT 23 SOUTH
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43113
Mailing Address - Country:US
Mailing Address - Phone:740-477-8544
Mailing Address - Fax:740-477-6124
Practice Address - Street 1:24561 ST RT 23 SOUTH
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113
Practice Address - Country:US
Practice Address - Phone:740-477-8544
Practice Address - Fax:740-477-6124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty