Organization
BLUE ASH ORAL AND MAXILLOFACIAL SURGERY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RANDALL DAVID STASTNY D.M.D. (OWNER)
(513) 984-2100
Entity
Organization
Contact information
Practice address
4350 MALSBARY RD, SUITE 201, CINCINNATI, OH 45242-5621
(513) 984-2100
(513) 984-2155
Mailing address
4350 MALSBARY RD, SUITE 201, CINCINNATI, OH 45242-5621
(513) 984-2100
(513) 984-2155
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
30-1-8892
OH
Other
Enumeration date
10/04/2006
Last updated
03/04/2008
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