Provider Demographics
NPI:1891172797
Name:ANDERSON ORAL AND MAXILLOFACIAL SURGERY
Entity Type:Organization
Organization Name:ANDERSON ORAL AND MAXILLOFACIAL SURGERY
Other - Org Name:AOMS,LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CORBIN
Authorized Official - Middle Name:G
Authorized Official - Last Name:PARTRDIGE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:317-841-1100
Mailing Address - Street 1:PO BOX 6268
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-6268
Mailing Address - Country:US
Mailing Address - Phone:317-841-1100
Mailing Address - Fax:
Practice Address - Street 1:1601 MEDICAL ARTS BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46011-3458
Practice Address - Country:US
Practice Address - Phone:765-298-4400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty