Provider Demographics
NPI:1356637557
Name:RICHMOND ORAL SURGERY ASSOCIATES ACQUISITION, LLC
Entity Type:Organization
Organization Name:RICHMOND ORAL SURGERY ASSOCIATES ACQUISITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:PAPADOPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:765-966-7537
Mailing Address - Street 1:888 SIM HODGIN PKWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1936
Mailing Address - Country:US
Mailing Address - Phone:765-966-7537
Mailing Address - Fax:765-966-0370
Practice Address - Street 1:888 SIM HODGIN PKWY
Practice Address - Street 2:SUITE C
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1936
Practice Address - Country:US
Practice Address - Phone:765-966-7537
Practice Address - Fax:765-966-0370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-26
Last Update Date:2011-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010966A1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty