Provider Demographics
NPI:1841479649
Name:AKRON ORAL & MAXILLOFACIAL SURGERY GROUP
Entity type:Organization
Organization Name:AKRON ORAL & MAXILLOFACIAL SURGERY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCDONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:330-836-2882
Mailing Address - Street 1:539 WHITE POND DRIVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320
Mailing Address - Country:US
Mailing Address - Phone:330-836-2882
Mailing Address - Fax:330-836-6085
Practice Address - Street 1:539 WHITE POND DRIVE
Practice Address - Street 2:SUITE C
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320
Practice Address - Country:US
Practice Address - Phone:330-836-2882
Practice Address - Fax:330-836-6085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH189321223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHMC0681744Medicare UPIN