Organization
MID OHIO ORAL SURGERY, INC.
Active
Organization
MID OHIO ORAL SURGERY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PHILLIP T LATHAM D.D.S. (PRESIDENT - SURGEON)
61418787778
Entity
Organization
Contact information
Practice address
4488 W BROAD ST, COLUMBUS, OH 43228-5610
(614) 878-7778
(614) 878-2725
Mailing address
4488 W BROAD ST, COLUMBUS, OH 43228-5610
(614) 878-7778
(614) 878-2725
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0417758
—
OH
Enumeration date
12/28/2006
Last updated
08/22/2020
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