| Stateline Oral & Maxillofacial Surgery, P.c. | |
|
4333 Monroe St Suite A Toledo OH 43606-1981 | |
| (419) 473-2707 | |
| (419) 473-0142 |
| Full Name | Stateline Oral & Maxillofacial Surgery, P.c. |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 4333 Monroe St, Toledo, Ohio |
| Authorized Official Name and Position | Timothy M. Lawrencde (PRESIDENT) |
| Authorized Official Contact | 4194732707 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Stateline Oral & Maxillofacial Surgery, P.c. 4333 Monroe St Suite A Toledo OH 43606-1981 Ph: (419) 473-2707 | Stateline Oral & Maxillofacial Surgery, P.c. 4333 Monroe St Suite A Toledo OH 43606-1981 Ph: (419) 473-2707 |
| NPI Number | 1659538155 |
|---|---|
| Provider Enumeration Date | 05/21/2008 |
| Last Update Date | 05/21/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659538155 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 30-16301 (Ohio) | Primary |
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