Organization
MAXILLOFACIAL SURGERY INNOVATIVE SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE ANN HANCOCK MS/P, MBA/HCM (CREDENTIALING DIRECTOR)
(515) 321-6451
Entity
Organization
Contact information
Practice address
1284 SOM CENTER RD STE 219, MAYFIELD HEIGHTS, OH 44124-2048
(888) 774-7773
(888) 774-7970
Mailing address
1284 SOM CENTER RD STE 219, MAYFIELD HEIGHTS, OH 44124-2048
(888) 774-7773
(888) 774-7970
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2855503
—
OH
Enumeration date
08/28/2017
Last updated
07/21/2022
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