# TERRE HAUTE ORAL & MAXILLOFACIAL SURGERY

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

## Provider details

- **NPI number:** 1487032538
- **Authorized official:** MRS. RUTH LEE (OFFICE MANAGER)
- **Authorized official phone:** (317) 373-4164

## Contact information

- **Practice address:** 3630 S 4TH ST, TERRE HAUTE, IN 47802-5543
- **Practice address phone:** (317) 373-4164
- **Mailing address:** 3630 S 4TH ST, TERRE HAUTE, IN 47802-5543

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 12010652A | IN | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 12010748A | IN | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 12011416A | IN | — |

## Other

- **Enumeration date:** 05/09/2015
- **Last updated:** 05/09/2015