Provider Demographics
NPI:1770591752
Name:COLUMBIA ORAL & MAXILLOFACIAL SURGERY LLC
Entity type:Organization
Organization Name:COLUMBIA ORAL & MAXILLOFACIAL SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:MD DDS
Authorized Official - Phone:573-443-0466
Mailing Address - Street 1:1000 W NIFONG BLVD
Mailing Address - Street 2:BLDG 4 STE 100
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-5661
Mailing Address - Country:US
Mailing Address - Phone:573-443-0466
Mailing Address - Fax:573-442-5417
Practice Address - Street 1:1000 W NIFONG BLVD
Practice Address - Street 2:BLDG 4 STE 100
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-5661
Practice Address - Country:US
Practice Address - Phone:573-443-0466
Practice Address - Fax:573-442-5417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty