# ORAL & MAXILLOFACIAL SURGERY ASSOCIATES PC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1831264324
- **Authorized official:** CELESTE C SHOLL (CREDENTIALING COORDINATOR)
- **Authorized official phone:** (260) 969-4113

## Contact information

- **Practice address:** 7845 CARNEGIE BLVD, FORT WAYNE, IN 46804
- **Practice address phone:** (260) 969-4105
- **Practice address fax:** (260) 969-4118
- **Mailing address:** 7845 CARNEGIE BLVD, FORT WAYNE, IN 46804-5792
- **Mailing address phone:** (260) 969-4105
- **Mailing address fax:** (260) 969-4118

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | — | NULL | — |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 11/21/2006
- **Last updated:** 08/18/2025