| Midwest Oral And Maxillofacial Surgery P C | |
|
3303 Trier Rd Fort Wayne IN 46815-4768 | |
| (260) 484-9990 | |
| (260) 484-6573 |
| Full Name | Midwest Oral And Maxillofacial Surgery P C |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 3303 Trier Rd, Fort Wayne, 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 3303 Trier Rd Fort Wayne IN 46815-4768 Ph: (260) 484-9990 |
| NPI Number | 1598781106 |
|---|---|
| Provider Enumeration Date | 07/15/2006 |
| Last Update Date | 10/12/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598781106 | NPI | - | NPPES |
| 200147450 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 54000677 (Indiana) | Primary |
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