# JEFFERSON CITY ORAL AND MAXILLOFACIAL SURGERY, LLC

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

## Provider details

- **NPI number:** 1760599732
- **Authorized official:** MRS. DANA KAY BAKER (OFFICE MANAGER)
- **Authorized official phone:** (573) 635-7216

## Contact information

- **Practice address:** 1400 SOUTHWEST BLVD, SUITE C, JEFFERSON CITY, MO 65109-2490
- **Practice address phone:** (573) 635-7216
- **Practice address fax:** (573) 635-2646
- **Mailing address:** 1400 SOUTHWEST BLVD, SUITE C, JEFFERSON CITY, MO 65109-2490
- **Mailing address phone:** (573) 635-7216
- **Mailing address fax:** (573) 635-2646

## 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:** 08/24/2006
- **Last updated:** 01/31/2008