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Organization
BLUE ASH ORAL AND MAXILLOFACIAL SURGERY, INC
Active
Organization
BLUE ASH ORAL AND MAXILLOFACIAL SURGERY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RANDALL DAVID STASTNY D.M.D. (OWNER)
(513) 984-2100
Entity
Organization
Contact information
Practice address
4350 MALSBARY RD, SUITE 201, CINCINNATI, OH 45242-5621
(513) 984-2100
(513) 984-2155
Mailing address
4350 MALSBARY RD, SUITE 201, CINCINNATI, OH 45242-5621
(513) 984-2100
(513) 984-2155
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
30-1-8892
OH
Other
Enumeration date
10/04/2006
Last updated
03/04/2008
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