Provider Demographics
NPI:1467506188
Name:ORAL SURGERY GROUP OF EVANSVILLE, INC
Entity Type:Organization
Organization Name:ORAL SURGERY GROUP OF EVANSVILLE, INC
Other - Org Name:TROYER & ALTEKRUSE DDS, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:KELLAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-425-5194
Mailing Address - Street 1:550 W VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710-1614
Mailing Address - Country:US
Mailing Address - Phone:812-425-5194
Mailing Address - Fax:812-426-9984
Practice Address - Street 1:550 W VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-1614
Practice Address - Country:US
Practice Address - Phone:812-425-5194
Practice Address - Fax:812-426-9984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN54000277A1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN847830Medicare ID - Type Unspecified