# KOKOMO IMPLANT AND ORAL SURGERY, LLC

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

## Provider details

- **NPI number:** 1992159552
- **Authorized official:** MRS. WENDY S. BEARD (OFFICE MANAGER)
- **Authorized official phone:** (317) 841-1100

## Contact information

- **Practice address:** 2008 WEST SYCAMORE STREET, KOKOMO, IN 46901-4112
- **Practice address phone:** (795) 452-0033
- **Practice address fax:** (765) 457-2175
- **Mailing address:** 9860 WESTPOINT DRIVE, SUITE 100, INDIANAPOLIS, IN 46256-3398
- **Mailing address phone:** (317) 841-1100
- **Mailing address fax:** (317) 841-2200

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 12007255A | IN | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 12010961A | IN | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 12012362A | IN | — |

## Other

- **Enumeration date:** 04/20/2016
- **Last updated:** 04/20/2016