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Organization
COLUMBUS ORAL & MAXILLOFACIAL SURGERY PC
Active
Organization
COLUMBUS ORAL & MAXILLOFACIAL SURGERY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN R SCUBA DDS (OWNER)
(706) 507-0901
Entity
Organization
Contact information
Practice address
4405 N STADIUM DR, SUITE A, COLUMBUS, GA 31909-1878
(706) 507-0901
(706) 507-0984
Mailing address
4405 N STADIUM DR, SUITE A, COLUMBUS, GA 31909-1875
(706) 507-0901
(706) 507-0984
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
DN013256
GA
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
052372
GA
2082S0099X
Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
052372
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
IP09476001
BCBS OF GA (M) GROUP
GA
Enumeration date
05/17/2007
Last updated
06/23/2008
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