Organization
AVON ORAL & MAXILLOFACIAL SURGERY LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM KINGERY (OFFICE MANAGER)
(317) 272-2200
Entity
Organization
Contact information
Practice address
6695 E US HIGHWAY 36, AVON, IN 46123-8923
(317) 272-2200
(317) 272-3714
Mailing address
6695 E US HIGHWAY 36, AVON, IN 46123-8923
(317) 272-2200
(317) 272-3714
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200298930A
—
IN
Enumeration date
06/01/2006
Last updated
08/20/2013
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