Provider Demographics
NPI:1760576813
Name:ORAL MAXILLO FACIAL SURGEONS, INC
Entity Type:Organization
Organization Name:ORAL MAXILLO FACIAL SURGEONS, INC
Other - Org Name:ORAL MAXILLOFACIAL & FACIAL PLASTIC SURGEONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-390-0770
Mailing Address - Street 1:13215 BIRCH DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-5431
Mailing Address - Country:US
Mailing Address - Phone:402-390-0770
Mailing Address - Fax:402-390-1074
Practice Address - Street 1:13215 BIRCH DR
Practice Address - Street 2:SUITE 100
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114
Practice Address - Country:US
Practice Address - Phone:402-390-0770
Practice Address - Fax:402-390-1074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty