# INDIAN LAND ORAL & FACIAL SURGERY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Greater Charlotte Oral & Facial Surgery
- **Organization subpart:** No

## Provider details

- **NPI number:** 1942794789
- **Authorized official:** LESLEY COYNER (CREDENTIALING)
- **Authorized official phone:** (304) 720-7819

## Contact information

- **Practice address:** 9787 CHARLOTTE HWY, FORT MILL, SC 29707-8103
- **Practice address phone:** (980) 939-1400
- **Mailing address:** 9789 CHARLOTTE HWY STE 400-207, FORT MILL, SC 29707-7177

## 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:** 06/15/2018
- **Last updated:** 06/15/2018