| Lafayette Oral And Maxillofacial Surgery Group, P.c. | |
|
2 Executive Dr Suite A Lafayette IN 47905-4859 | |
| (765) 807-0230 | |
| (765) 807-0234 |
| Full Name | Lafayette Oral And Maxillofacial Surgery Group, P.c. |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 2 Executive Dr, Lafayette, Indiana |
| Authorized Official Name and Position | Brett Anthony Henrikson (PRESIDENT) |
| Authorized Official Contact | 7658070230 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lafayette Oral And Maxillofacial Surgery Group, P.c. 2 Executive Dr Suite A Lafayette IN 47905-4859 Ph: (765) 807-0230 | Lafayette Oral And Maxillofacial Surgery Group, P.c. 2 Executive Dr Suite A Lafayette IN 47905-4859 Ph: (765) 807-0230 |
| NPI Number | 1972685238 |
|---|---|
| Provider Enumeration Date | 10/19/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972685238 | NPI | - | NPPES |
| 600000340871 | Other | IN | ANTHEM BC/BS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 1201055A (Indiana) | Primary |
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