MIDWEST ORAL AND MAXILLOFACIAL SURGERY P C (NPI# 1598781106) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1598781106 |
| Entity Type | Organization |
| Organization Name | MIDWEST ORAL AND MAXILLOFACIAL SURGERY P C |
| Practice Address |
3303 Trier Rd Fort Wayne IN 46815-4768 |
| Practice Telephone | 2604849990 |
| Practice Fax Number | 2604846573 |
| Mailing Telephone | 2604849990 |
| Mailing Fax Number | 2604846573 |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2010-10-12 |
| Authorized Official Name | MICHAEL L. ICZKOVITZ (PRESIDENT) |
| Authorized Official Telephone | 2604849990 |
| Authorized Official Credential | D.D.S. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
54000677 | IN | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 200147450 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467507798 | Midwest Oral and Maxillofacial Surgery P C | Dentist | 516 N Line St, Columbia City, IN 46725-1230 | 2007-01-25 |
| 1649316183 | Midwest Oral and Maxillofacial Surgery P C | Dentist | 358 E Chicago St, Suite 200-a, Coldwater, MI 49036-2072 | 2007-01-30 |
| 1558416883 | Midwest Oral and Maxillofacial Surgery P C | Dentist | 7230 Engle Rd, Suite 301, Fort Wayne, IN 46804-2209 | 2007-01-25 |
| Street Address |
3303 TRIER RD |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46815-4768 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982830766 | Yash Kumar Singh | Dentist | 3303 Trier Rd, Fort Wayne, IN 46815-4768 | 2009-06-07 |
| 1942359393 | Jack Joseph Wehrly | Dentist | 3303 Trier Rd, Fort Wayne, IN 46815-4768 | 2007-01-08 |
| 1235159930 | Michael L Iczkovitz | Dentist | 3303 Trier Rd, Fort Wayne, IN 46815-4768 | 2006-07-19 |
| 1649290354 | Robert E. Braun | Dentist | 3303 Trier Rd, Fort Wayne, IN 46815-4768 | 2006-07-19 |
| 1437179140 | Robert L Reifeis | Dentist | 3303 Trier Rd, Fort Wayne, IN 46815-4768 | 2006-07-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306305438 | Sullivan Services, Inc. | In Home Supportive Care | 2789-b Maplecrest Rd, Fort Wayne, IN 46815 | 2019-03-18 |
| 1598250144 | Altermease Gleason | Massage Therapist | 3406 Thames Drive, Fort Wayne, IN 46815 | 2018-06-26 |
| 1881000222 | Denise Sparks | Specialist | 6415 Benham Drive, Fort Wayne, IN 46815 | 2014-07-07 |
| 1962823138 | Chad Distelrath | Physical Therapy Assistant | 1717 Maplecrest Rd, Apt 112, Fort Wayne, IN 46815 | 2013-12-13 |
| 1689943409 | Kendall Joan Labrash | Physical Therapist | 4251 Lahmeyer Rd., Fort Wayne, IN 46815 | 2011-12-22 |
| 1801179718 | Jayson Laube | Pharmacist | 6201 Stellhorn, Fort Wayne, IN 46815 | 2011-09-27 |
| 1720294432 | Muscle Therapy Clinic LLC | Massage Therapist | 6409 Georgetown North Blvd, Fort Wayne, IN 46815 | 2007-05-16 |
| 1427186436 | Legoras Conture Fashions | Prosthetic/Orthotic Supplier | 3316 Inwood Drive, Fort Wayne, IN 46815 | 2007-03-01 |
| 1932252772 | Fort Wayne Smiles PC | Dentist | 2031 Reed Road, Fort Wayne, IN 46815 | 2007-01-18 |
| 1811078538 | Timothy Doody Lynch | Dentist | 4207 Hobson Court, Fort Wayne, IN 46815 | 2006-10-18 |
| Find all providers in zip 46815 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093250151 | Ruckman Oral Surgery and Implant Center LLC | Dentist | 9901 Auburn Rd, Fort Wayne, IN 46825-2345 | 2016-12-28 |
| 1942399159 | Ryan M. Diepenbrock | Dentist | 7845 Carnegie Blvd Ste A, Fort Wayne, IN 46804-5792 | 2006-10-12 |
| 1245240399 | Michael J Stronczek | Dentist | 7845 Carnegie Blvd, Fort Wayne, IN 46804-5792 | 2006-08-09 |
| 1487664512 | David G Bojrab | Dentist | 4606 D East State Blvd, Fort Wayne, IN 46815 | 2006-08-09 |
| 1154349439 | John Jacob Shank | Dentist | 2121 E Dupont Rd Ste C, Fort Wayne, IN 46825-1546 | 2006-07-17 |
| 1326421637 | James E. Dumas, Dds, PC | Dentist | 10020 Dupont Circle Ct., Suite 150, Fort Wayne, IN 46825-1635 | 2015-07-06 |
| 1982830766 | Yash Kumar Singh | Dentist | 3303 Trier Rd, Fort Wayne, IN 46815-4768 | 2009-06-07 |
| 1033366711 | Lucas S Reed | Dentist | 7845 Carnegie Blvd, Fort Wayne, IN 46804-5792 | 2008-08-25 |
| 1376701045 | James Terrence O'neill | Dentist | 7845 Carnegie Blvd, Fort Wayne, IN 46804 | 2008-05-29 |
| 1558416883 | Midwest Oral and Maxillofacial Surgery P C | Dentist | 7230 Engle Rd, Suite 301, Fort Wayne, IN 46804-2209 | 2007-01-25 |
| Find all providers in FORT WAYNE | ||||
| City | FORT WAYNE |
| Zip Code | 46815 |
Please comment or provide details below to improve the information on MIDWEST ORAL AND MAXILLOFACIAL SURGERY P C.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.