# EASTGATE ORAL SURGERY AND IMPLANTS

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

## Provider details

- **NPI number:** 1689479248
- **Authorized official:** WALLACE S MCLAURIN DMD (OWNER/OPERATOR)
- **Authorized official phone:** (601) 259-6739

## Contact information

- **Practice address:** 4452 EASTGATE BLVD STE 107, CINCINNATI, OH 45245-1584
- **Practice address phone:** (513) 643-3192
- **Mailing address:** 4452 EASTGATE BLVD STE 107, CINCINNATI, OH 45245-1584
- **Mailing address phone:** (513) 643-3192

## 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:** 02/18/2025
- **Last updated:** 02/18/2025