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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