| Oral And Maxillofacial Surgery, P.c. | |
|
1612 N Baldwin Ave Marion IN 46952-1872 | |
| (765) 662-2068 | |
| (765) 662-3210 |
| Full Name | Oral And Maxillofacial Surgery, P.c. |
|---|---|
| Speciality | Dentist |
| Location | 1612 N Baldwin Ave, Marion, Indiana |
| Authorized Official Name and Position | Lynn E Johnson (OFFICE MANAGER) |
| Authorized Official Contact | 7656622068 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Oral And Maxillofacial Surgery, P.c. 1612 N Baldwin Ave Marion IN 46952-1872 Ph: (765) 662-2068 | Oral And Maxillofacial Surgery, P.c. 1612 N Baldwin Ave Marion IN 46952-1872 Ph: (765) 662-2068 |
| NPI Number | 1235248329 |
|---|---|
| Provider Enumeration Date | 08/30/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 5294922001 |
|---|---|
| Medicare Enrollment ID | O20101206001016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235248329 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 1223S0112X (Indiana) | Primary |
| Provider Name | Carlo C Lo |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1417991639 PECOS PAC ID: 8325285612 Enrollment ID: I20130503000451 |
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