Provider Demographics
NPI:1982696175
Name:ORAL & MAXILLOFACIAL SURGEONS INC
Entity Type:Organization
Organization Name:ORAL & MAXILLOFACIAL SURGEONS INC
Other - Org Name:HARBOR LIGHT ORAL & MAXILLOFACIAL SURGEONS INC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCCABE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:419-517-2100
Mailing Address - Street 1:4646 NANTUCKETT DR STE A
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-3194
Mailing Address - Country:US
Mailing Address - Phone:419-517-2100
Mailing Address - Fax:419-517-2105
Practice Address - Street 1:970 W WOOSTER ST
Practice Address - Street 2:SUITE 126
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-2643
Practice Address - Country:US
Practice Address - Phone:419-353-2100
Practice Address - Fax:419-353-6606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2241498Medicaid
OH2241489Medicaid
OHDB2868OtherRR MEDICARE
OH2241489Medicaid