Provider Demographics
NPI:1205854791
Name:MONESMITH & WOOD ORAL AND MAXILLOFACIAL SURGERY PC
Entity Type:Organization
Organization Name:MONESMITH & WOOD ORAL AND MAXILLOFACIAL SURGERY PC
Other - Org Name:MATTHEW B MONESMITH DDS PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT ORAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:MONESMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:812-482-2280
Mailing Address - Street 1:2005 ST CHARLES STREET
Mailing Address - Street 2:SUITE 2
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-9146
Mailing Address - Country:US
Mailing Address - Phone:812-482-2280
Mailing Address - Fax:812-482-4218
Practice Address - Street 1:2005 ST CHARLES STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-9146
Practice Address - Country:US
Practice Address - Phone:812-482-2280
Practice Address - Fax:812-482-4218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120091371223S0112X
IN12009891A1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000351646OtherANTHEM
IN000000093454OtherANTHEM
U80114Medicare UPIN
U42738Medicare UPIN
224140Medicare ID - Type Unspecified