Provider Demographics
NPI:1861663106
Name:CENTER FOR ORAL AND MAXILLOFACIAL SURGERY
Entity Type:Organization
Organization Name:CENTER FOR ORAL AND MAXILLOFACIAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:P
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:440-871-2201
Mailing Address - Street 1:28871 CENTER RIDGE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-5271
Mailing Address - Country:US
Mailing Address - Phone:440-871-2201
Mailing Address - Fax:440-871-2204
Practice Address - Street 1:28871 CENTER RIDGE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5271
Practice Address - Country:US
Practice Address - Phone:440-871-2201
Practice Address - Fax:440-871-2204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH17516261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHT80577Medicare UPIN