Organization
PLAINFIELD ORAL & MAXILLOFACIAL SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUTH LEE (PRACTICE ADMINISTRATOR)
(317) 527-0066
Entity
Organization
Contact information
Practice address
803 EDWARDS DR, PLAINFIELD, IN 46168-2785
(317) 527-0066
Mailing address
803 EDWARDS DR, PLAINFIELD, IN 46168-2785
(317) 527-0066
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
12010748A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200932660
—
IN
Enumeration date
12/29/2016
Last updated
12/29/2016
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