Provider Demographics
NPI:1336166289
Name:CARNES, MONTGOMERY, COOK & HENRY, ORAL & MAX SURG, LLC
Entity Type:Organization
Organization Name:CARNES, MONTGOMERY, COOK & HENRY, ORAL & MAX SURG, LLC
Other - Org Name:NORTHWEST ORAL & FACIAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:GRASSETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-885-3339
Mailing Address - Street 1:6641 N HIGH ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-4038
Mailing Address - Country:US
Mailing Address - Phone:614-885-3339
Mailing Address - Fax:614-885-1011
Practice Address - Street 1:6641 N HIGH ST
Practice Address - Street 2:SUITE 105
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-4038
Practice Address - Country:US
Practice Address - Phone:614-885-3339
Practice Address - Fax:614-885-1011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9278701Medicare PIN