# RICHMOND ORAL & MAXILLOFACIAL SURGERY,LLC

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

## Provider details

- **NPI number:** 1790105203
- **Authorized official:** MRS. WENDY S BEARD (OFFICE MANAGER)
- **Authorized official phone:** (317) 841-1100

## Contact information

- **Practice address:** 1004 OAK DR, RICHMOND, IN 47374-1916
- **Practice address phone:** (765) 935-1997
- **Practice address fax:** (765) 939-2861
- **Mailing address:** 1004 OAK DR, RICHMOND, IN 47374-1916
- **Mailing address phone:** (765) 935-1997
- **Mailing address fax:** (765) 939-2861

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 12010160A | IN | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 12010961A | IN | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 12011603A | IN | — |

## Other

- **Enumeration date:** 04/23/2014
- **Last updated:** 04/23/2014