| Champaign Oral Surgery Center | |
|
14 E Anthony Dr Suite C Champaign IL 61820-2748 | |
| (217) 355-2809 | |
| (217) 355-5921 |
| Full Name | Champaign Oral Surgery Center |
|---|---|
| Speciality | Dentist |
| Location | 14 E Anthony Dr, Champaign, Illinois |
| Authorized Official Name and Position | Amy M Kroeger (INSURANCE COORDINATOR) |
| Authorized Official Contact | 2175405100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Champaign Oral Surgery Center 14 E Anthony Dr Suite C Champaign IL 61820-2748 Ph: (217) 355-2809 | Champaign Oral Surgery Center 14 E Anthony Dr Suite C Champaign IL 61820-2748 Ph: (217) 355-2809 |
| NPI Number | 1669540399 |
|---|---|
| Provider Enumeration Date | 12/01/2006 |
| Last Update Date | 08/23/2023 |
| Medicare PECOS PAC ID | 4486655529 |
|---|---|
| Medicare Enrollment ID | O20070116000497 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669540399 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
| Provider Name | Thomas W Fonner |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1205907581 PECOS PAC ID: 8921009069 Enrollment ID: I20070116000508 |
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