Provider Demographics
NPI:1447736715
Name:COLUMBIA ORAL AND MAXILLOFACIAL SERVICES, LLC
Entity Type:Organization
Organization Name:COLUMBIA ORAL AND MAXILLOFACIAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EVA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRABUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-443-0466
Mailing Address - Street 1:1000 W NIFONG BLVD
Mailing Address - Street 2:BLDG 4 SUITE 100
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201
Mailing Address - Country:US
Mailing Address - Phone:573-443-0466
Mailing Address - Fax:573-442-5417
Practice Address - Street 1:1000 W NIFONG BLVD
Practice Address - Street 2:BLDG 4 SUITE 100
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201
Practice Address - Country:US
Practice Address - Phone:573-443-0466
Practice Address - Fax:573-442-5417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1538272976OtherINDIVIDUAL NPI FOR ANDREWS
MO1891006557OtherINDIVIDUAL NPI FOR ATWOOD