# ORAL SURGERY OF INDIANA, LLC

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

## Provider details

- **NPI number:** 1376181347
- **Authorized official:** TAMONIA LEONARD (CREDENTAILING SPECIALIST)
- **Authorized official phone:** (678) 244-4844

## Contact information

- **Practice address:** 620 S TILLOTSON AVE, MUNCIE, IN 47304-4448
- **Practice address phone:** (770) 692-1000
- **Mailing address:** 620 S TILLOTSON AVE, MUNCIE, IN 47304-4448
- **Mailing address phone:** (770) 692-1000

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |
| 261QD0000X | Dental Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 12/20/2019
- **Last updated:** 12/20/2019