Provider Demographics
NPI:1043427883
Name:ORAL AND FACIAL SURGEONS OF OHIO
Entity Type:Organization
Organization Name:ORAL AND FACIAL SURGEONS OF OHIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:614-764-9455
Mailing Address - Street 1:5155 BRADENTON AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-7558
Mailing Address - Country:US
Mailing Address - Phone:614-764-9455
Mailing Address - Fax:614-526-3745
Practice Address - Street 1:5155 BRADENTON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-7558
Practice Address - Country:US
Practice Address - Phone:614-764-9455
Practice Address - Fax:614-526-3745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300164871223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty