# TRI-STATE ORAL SURGERY, LLC

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

## Provider details

- **NPI number:** 1710366323
- **Authorized official:** DR. MARK E. WOHLFORD DDS, PHD (OWNER)
- **Authorized official phone:** (812) 401-3500

## Contact information

- **Practice address:** 405 BENTEE WES CT, EVANSVILLE, IN 47715-4061
- **Practice address phone:** (812) 401-3500
- **Practice address fax:** (812) 401-3600
- **Mailing address:** 405 BENTEE WES CT, EVANSVILLE, IN 47715-4061
- **Mailing address phone:** (812) 401-3500
- **Mailing address fax:** (812) 401-3600

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 12009501A | IN | Yes |

## Other

- **Enumeration date:** 05/28/2015
- **Last updated:** 05/28/2015