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Organization
EASTGATE ORAL SURGERY AND IMPLANTS
Active
Organization
EASTGATE ORAL SURGERY AND IMPLANTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WALLACE S MCLAURIN DMD (OWNER/OPERATOR)
(601) 259-6739
Entity
Organization
Contact information
Practice address
4452 EASTGATE BLVD STE 107, CINCINNATI, OH 45245-1584
(513) 643-3192
Mailing address
4452 EASTGATE BLVD STE 107, CINCINNATI, OH 45245-1584
(513) 643-3192
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
NULL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
02/18/2025
Last updated
02/18/2025
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