| Oral Surgery Office Llc | |
|
2204 Scott St Lafayette IN 47904-2933 | |
| (765) 447-0525 | |
| (765) 447-5815 |
| Full Name | Oral Surgery Office Llc |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 2204 Scott St, Lafayette, Indiana |
| Authorized Official Name and Position | David Brian Coates (CO-OWNER) |
| Authorized Official Contact | 7654470525 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Oral Surgery Office Llc 2204 Scott St Lafayette IN 47904-2933 Ph: (765) 447-0525 | Oral Surgery Office Llc 2204 Scott St Lafayette IN 47904-2933 Ph: (765) 447-0525 |
| NPI Number | 1881696847 |
|---|---|
| Provider Enumeration Date | 06/02/2005 |
| Last Update Date | 07/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881696847 | NPI | - | NPPES |
| 100232750A | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (Indiana) | Primary |
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