Provider Demographics
NPI:1184034720
Name:ORAL SURGICAL INSTITUTE
Entity Type:Organization
Organization Name:ORAL SURGICAL INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:HARDEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:407-625-3646
Mailing Address - Street 1:PO BOX 691747
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32869-1747
Mailing Address - Country:US
Mailing Address - Phone:407-625-3646
Mailing Address - Fax:
Practice Address - Street 1:1291 WINTER GARDEN VINELAND RD
Practice Address - Street 2:150
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-6705
Practice Address - Country:US
Practice Address - Phone:407-625-3646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-05
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty