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Oral Surgery, Dental Specialists

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Dental Care Facilities

Brazil, Indiana

Provider NPI: 1528542370

Organization Information:
Organization is not Subpart
Authorized Official:  TYLER  RICHEY  OWNER  812-4483639

Practice Location:
Tel: 812-448-3639  Fax: --

Business Mailing Address:
Tel: 812-448-3639  Fax: --

Entity Type: Organization


PrimaryCodeCategory/DescriptionStateLicense Number
Y261QD0000XAmbulatory Health Care Facilities

Other Provider Identifiers:

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin


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