| NPI | 1679746580 |
|---|---|
| Doing Business As | NORTHEAST ORAL & MAXILLOFACIAL SURGERY |
| Entity Type | Organization |
| Authorized Contact | WENDY S BEARD Office Manager 317-841-1100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IN 12007989B) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IN 12007989A) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IN 12010961A) | |
| Enumeration Date | 2008-04-11 |
| Last Update Date | 2010-02-12 |