Organization
TERRE HAUTE ORAL & MAXILLOFACIAL SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. RUTH LEE (OFFICE MANAGER)
(317) 373-4164
Entity
Organization
Contact information
Practice address
3630 S 4TH ST, TERRE HAUTE, IN 47802-5543
(317) 373-4164
Mailing address
3630 S 4TH ST, TERRE HAUTE, IN 47802-5543
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
12010652A
IN
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
12010748A
IN
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
12011416A
IN
Other
Enumeration date
05/09/2015
Last updated
05/09/2015
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