# ORAL AND MAXILLOFACIAL SURGERY, P.C.

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

## Provider details

- **NPI number:** 1235248329
- **Authorized official:** MS. LYNN E JOHNSON (OFFICE MANAGER)
- **Authorized official phone:** (765) 662-2068

## Contact information

- **Practice address:** 1612 N BALDWIN AVE, MARION, IN 46952-1872
- **Practice address phone:** (765) 662-2068
- **Practice address fax:** (765) 662-3210
- **Mailing address:** 1612 N BALDWIN AVE, MARION, IN 46952-1872
- **Mailing address phone:** (765) 662-2068
- **Mailing address fax:** (765) 662-3210

## Taxonomy

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

## Other

- **Enumeration date:** 08/30/2006
- **Last updated:** 08/22/2020