# MID OHIO ORAL SURGERY, INC.

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

## Provider details

- **NPI number:** 1356407258
- **Authorized official:** DR. PHILLIP T LATHAM D.D.S. (PRESIDENT - SURGEON)
- **Authorized official phone:** 61418787778

## Contact information

- **Practice address:** 4488 W BROAD ST, COLUMBUS, OH 43228-5610
- **Practice address phone:** (614) 878-7778
- **Practice address fax:** (614) 878-2725
- **Mailing address:** 4488 W BROAD ST, COLUMBUS, OH 43228-5610
- **Mailing address phone:** (614) 878-7778
- **Mailing address fax:** (614) 878-2725

## 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:** 12/28/2006
- **Last updated:** 08/22/2020