Organization
COLUMBIA ORAL AND MAXILLOFACIAL SERVICES, LLC
Active
Organization
COLUMBIA ORAL AND MAXILLOFACIAL SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EVA TRABUE (OFFICE MANAGER)
(573) 443-0466
Entity
Organization
Contact information
Practice address
1000 W NIFONG BLVD, BLDG 4 SUITE 100, COLUMBIA, MO 65201
(573) 443-0466
(573) 442-5417
Mailing address
1000 W NIFONG BLVD, BLDG 4 SUITE 100, COLUMBIA, MO 65201
(573) 443-0466
(573) 442-5417
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1538272976
INDIVIDUAL NPI FOR ANDREWS
MO
01
—
1891006557
INDIVIDUAL NPI FOR ATWOOD
MO
Enumeration date
07/19/2018
Last updated
07/19/2018
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