Organization
ORAL & MAXILLOFACIAL SURGERY ASSOCIATES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CELESTE C SHOLL (CREDENTIALING COORDINATOR)
(260) 969-4113
Entity
Organization
Contact information
Practice address
7845 CARNEGIE BLVD, FORT WAYNE, IN 46804
(260) 969-4105
(260) 969-4118
Mailing address
7845 CARNEGIE BLVD, FORT WAYNE, IN 46804-5792
(260) 969-4105
(260) 969-4118
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200029030
—
IN
01
—
6185590001
DME MAC
IN
Enumeration date
11/21/2006
Last updated
08/18/2025
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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