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Oral and Maxillofacial Surgery

Medina, Ohio

Provider NPI: 1811076979

Provider Information:
Gender: M
Sole Proprietor

Practice Location:
5002 FOOTE RD  MEDINA, OH 44256 US
Tel: 330-725-8449  Fax: 330-722-1805

Business Mailing Address:
5002 FOOTE RD  MEDINA, OH 44256 US
Tel: 330-725-8449  Fax: 330-722-1805

Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Y1223S0112XDental Providers
Oral and Maxillofacial Surgery

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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