Provider Demographics
NPI:1013266295
Name:NEW ALBANY JAW AND FACIAL SURGERY
Entity Type:Organization
Organization Name:NEW ALBANY JAW AND FACIAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING OFFICE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:R
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-751-7500
Mailing Address - Street 1:1575 CROSS CREEKS BLVD
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-8237
Mailing Address - Country:US
Mailing Address - Phone:614-751-7500
Mailing Address - Fax:614-322-7900
Practice Address - Street 1:5101 FOREST DR
Practice Address - Street 2:SUITE B
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054-8215
Practice Address - Country:US
Practice Address - Phone:614-751-7500
Practice Address - Fax:614-322-7900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-04
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH201621223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty