# ORAL AND MAXILLOFACIAL SURGERY CENTER OF LAFAYETTE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154411163
- **Authorized official:** COURTNEY A JAMES (OFFICE MANAGER)
- **Authorized official phone:** (765) 446-8808

## Contact information

- **Practice address:** 2020 UNION STREET, SUITE 200, LAFAYETTE, IN 47904
- **Practice address phone:** (765) 446-8808
- **Practice address fax:** (765) 446-9567
- **Mailing address:** 2020 UNION STREET, SUITE 200, LAFAYETTE, IN 47904
- **Mailing address phone:** (765) 446-8808
- **Mailing address fax:** (765) 446-9567

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 10/13/2006
- **Last updated:** 02/27/2009