Provider Demographics
NPI:1831543701
Name:EAST COLUMBUS ORAL SURGERY SPECIALISTS INC.
Entity type:Organization
Organization Name:EAST COLUMBUS ORAL SURGERY SPECIALISTS INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER / SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:VON KAENEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:614-427-0400
Mailing Address - Street 1:6555 E BROAD ST.
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213
Mailing Address - Country:US
Mailing Address - Phone:614-427-0400
Mailing Address - Fax:
Practice Address - Street 1:6555 E BROAD ST.
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213
Practice Address - Country:US
Practice Address - Phone:614-427-0400
Practice Address - Fax:614-427-0735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-18
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30023253204E00000X
OH30022741204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty