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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