Provider Demographics
NPI:1851618847
Name:AOSDI, GLENN J MAKOWSKI, DMD, MD, PC
Entity Type:Organization
Organization Name:AOSDI, GLENN J MAKOWSKI, DMD, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, ORAL MAXILLOFACIAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:417-623-2000
Mailing Address - Street 1:2602 CUNNINGHAM AVE
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1542
Mailing Address - Country:US
Mailing Address - Phone:417-623-2000
Mailing Address - Fax:417-623-7948
Practice Address - Street 1:2602 CUNNINGHAM AVE
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1542
Practice Address - Country:US
Practice Address - Phone:417-623-2000
Practice Address - Fax:417-623-7948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty