Organization
ORAL SURGERY OF INDIANA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAMONIA LEONARD (CREDENTAILING SPECIALIST)
(678) 244-4844
Entity
Organization
Contact information
Practice address
620 S TILLOTSON AVE, MUNCIE, IN 47304-4448
(770) 692-1000
Mailing address
620 S TILLOTSON AVE, MUNCIE, IN 47304-4448
(770) 692-1000
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
261QD0000X
Dental Clinic/Center
—
—
Other
Enumeration date
12/20/2019
Last updated
12/20/2019
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