Organization
KOKOMO IMPLANT AND ORAL 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
2008 WEST SYCAMORE STREET, KOKOMO, IN 46901-4112
(795) 452-0033
(765) 457-2175
Mailing address
9860 WESTPOINT DRIVE, SUITE 100, INDIANAPOLIS, IN 46256-3398
(317) 841-1100
(317) 841-2200
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
12007255A
IN
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
12010961A
IN
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
12012362A
IN
Other
Enumeration date
04/20/2016
Last updated
04/20/2016
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