Organization
BUCKEYE ORAL & MAXILLOFACIAL SURGEY
Active
Other names
Buckeye Oral & Maxillofacial Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACK B MCEWAN DDS (OWNER)
(614) 794-9700
Entity
Organization
Contact information
Practice address
110 POLARIS PARKWAY, SUITE 110, WESTERVILLE, OH 43082-0000
(614) 794-9700
Mailing address
PO BOX 2443, WESTERVILLE, OH 43086-2443
(614) 794-9700
Taxonomy
Speciality
Code
Description
License number
State
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
30022456
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2711882
—
OH
Enumeration date
03/27/2013
Last updated
03/27/2013
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