| Midwest Oral And Maxillofacial Surgery P C | |
|
516 N Line St Columbia City IN 46725-1230 | |
| (260) 244-4007 | |
| Not Available |
| Full Name | Midwest Oral And Maxillofacial Surgery P C |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 516 N Line St, Columbia City, Indiana |
| Authorized Official Name and Position | Michael L Iczkovitz (PRESIDENT) |
| Authorized Official Contact | 2604849990 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Midwest Oral And Maxillofacial Surgery P C 3303 Trier Rd Fort Wayne IN 46815-4768 Ph: (260) 484-9990 | Midwest Oral And Maxillofacial Surgery P C 516 N Line St Columbia City IN 46725-1230 Ph: (260) 244-4007 |
| NPI Number | 1467507798 |
|---|---|
| Provider Enumeration Date | 01/25/2007 |
| Last Update Date | 03/26/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467507798 | NPI | - | NPPES |
| 200147450 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 54000677 (Indiana) | Primary |
Gfd Cc Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 506 N Line St, Columbia City, IN 46725 Phone: 260-248-4242 | |
Patterson Family Dentistry, P.c. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 788 W Connexion Way Unit A, Columbia City, IN 46725 Phone: 260-248-4858 Fax: 260-248-4859 |