ORAL & MAXILLOFACIAL SURGERY ASSOCIATES PC (NPI# 1831264324) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1831264324 |
| Entity Type | Organization |
| Organization Name | ORAL & MAXILLOFACIAL SURGERY ASSOCIATES PC |
| Practice Address |
7845 Carnegie Blvd Fort Wayne IN 46804 |
| Mailing Address |
7845 Carnegie Blvd Fort Wayne IN 46804-5792 |
| Practice Telephone | 2609694105 |
| Practice Fax Number | 2609694118 |
| Mailing Telephone | 2609694105 |
| Mailing Fax Number | 2609694118 |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2020-07-09 |
| Authorized Official Name | CELESTE C SHOLL (CDA) |
| Authorized Official Telephone | 2604232340 |
| Authorized Official Credential | CDA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 204E00000X | Oral & Maxillofacial Surgery | Allopathic & Osteopathic Physicians | ||
| N | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 200029030 | 05 | |
| IN | NGS DME MAC | 6185590001 | 01 |
| IN | DME MAC | 6185590001 | 01 |
| Street Address |
7845 CARNEGIE BLVD |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46804 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245240399 | Michael J Stronczek | Dentist | 7845 Carnegie Blvd, Fort Wayne, IN 46804-5792 | 2006-08-09 |
| 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 |
| 1801806948 | Steven J Butler | Dentist | 7845 Carnegie Blvd, Fort Wayne, IN 46804 | 2006-08-09 |
| 1538179684 | Steven R Schimmele | Dentist | 7845 Carnegie Blvd, Fort Wayne, IN 46804-5792 | 2006-08-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396350344 | Derek Mumaw | Physical Therapist | 8420 Illinois Rd, Fort Wayne, IN 46804 | 2020-09-15 |
| 1942840228 | Erin M Mason | Behavior Technician | 5601 Coventry Ln, Fort Wayne, IN 46804 | 2020-01-14 |
| 1346880879 | Emily A Abdalla | Behavior Technician | 5601 Coventry Ln., Fort Wayne, IN 46804 | 2020-01-13 |
| 1083265433 | Fort Wayne Endodontics | Dentist | 9407 Illinois Rd, Fort Wayne, IN 46804 | 2019-09-26 |
| 1689140949 | Harrison Dental Group II, LLC | Dentist | 1333 Getz Rd, Fort Wayne, IN 46804 | 2018-10-15 |
| 1346731908 | Erin Nicole Zimmerman | Nurse Practitioner | 10170 Illinois Rd # 14, Fort Wayne, IN 46804 | 2018-05-19 |
| 1417446022 | Mary Harrington | Physical Therapist | 3320 Copper Hill Run, Fort Wayne, IN 46804 | 2018-05-09 |
| 1942701214 | Joshawa Todd Torres | Marriage & Family Therapist | 5651 Coventry Ln # 116, Fort Wayne, IN 46804 | 2018-02-22 |
| 1194235408 | Mitchell Kory Meyer | Specialist/Technologist | 9125 Yellow Tree Ct, Fort Wayne, IN 46804 | 2017-10-02 |
| 1902324916 | Emily Rene Sagstetter | Specialist/Technologist | 6034 Liberty Glade Ct, Fort Wayne, IN 46804 | 2017-08-30 |
| Find all providers in zip 46804 | ||||
| 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 |
| 1598781106 | Midwest Oral and Maxillofacial Surgery P C | Dentist | 3303 Trier Rd, Fort Wayne, IN 46815-4768 | 2006-07-15 |
| 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 |
| Find all providers in FORT WAYNE | ||||
| City | FORT WAYNE |
| Zip Code | 46804 |
Please comment or provide details below to improve the information on ORAL & MAXILLOFACIAL SURGERY ASSOCIATES PC.
| 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.