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Organization

RICHMOND ORAL & MAXILLOFACIAL SURGERY,LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. WENDY S BEARD (OFFICE MANAGER)
(317) 841-1100
Entity
Organization

Contact information

Practice address
1004 OAK DR, RICHMOND, IN 47374-1916
(765) 935-1997
(765) 939-2861
Mailing address
1004 OAK DR, RICHMOND, IN 47374-1916
(765) 935-1997
(765) 939-2861

Taxonomy

Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
12010160A
IN
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
12010961A
IN
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
12011603A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
PENDING
IN
Enumeration date
04/23/2014
Last updated
04/23/2014
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