LAFAYETTE ORAL AND MAXILLOFACIAL SURGERY GROUP, P.C. (NPI# 1972685238) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972685238 |
| Entity Type | Organization |
| Organization Name | LAFAYETTE ORAL AND MAXILLOFACIAL SURGERY GROUP, P.C. |
| Practice Address |
2 Executive Dr Suite A Lafayette IN 47905-4859 |
| Practice Telephone | 7658070230 |
| Practice Fax Number | 7658070234 |
| Mailing Telephone | 7658070230 |
| Mailing Fax Number | 7658070234 |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. BRETT ANTHONY HENRIKSON (PRESIDENT) |
| Authorized Official Telephone | 7658070230 |
| 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 |
1201055A | IN | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | ANTHEM BC/BS | 600000340871 | 01 |
| Street Address |
2 EXECUTIVE DR SUITE A |
| City | LAFAYETTE |
| State | IN |
| Zip Code | 47905-4859 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972520997 | Wellbound of Lafayette LLC | Clinic/Center | 2 Executive Dr, Suite B, Lafayette, IN 47905-4878 | 2006-07-16 |
| 1982213245 | Chul Ho Yang | Dentist | 2 Executive Dr, Lafayette, IN 47905-4878 | 2020-07-23 |
| 1669025441 | Karthika Basireddy | Dentist | 2 Executive Dr, Lafayette, IN 47905-4878 | 2019-07-19 |
| 1801317573 | Virajitha Velichala | Dentist | 2 Executive Dr, Lafayette, IN 47905-4878 | 2017-07-03 |
| 1487026431 | Lakewood Family Dental of Lafayette Inc | Dentist | 2 Executive Dr, Lafayette, IN 47905-4878 | 2015-10-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538719893 | Elements Counseling LLC | Social Worker | 115 N. Farabee Drive, Lafayette, IN 47905 | 2019-09-18 |
| 1134596869 | Indiana Dental Sleep Therapy LLC | Dentist | 4921 Sr 26 E, Suite 300, Lafayette, IN 47905 | 2015-08-28 |
| 1255750899 | Emily S Miller | Physical Therapist | 1701 Creasy Ln, Lafayette, IN 47905 | 2014-04-10 |
| 1073876215 | Nathan Webster | Dentist | 1530 Kossuth St., Lafayette, IN 47905 | 2012-06-22 |
| 1578848370 | Mark Jin Kim | Pharmacist | 1801 South St., Lafayette, IN 47905 | 2011-10-13 |
| 1700177185 | Shannon Tawn Harris | Speech-Language Pathologist | 8900 Cobbler Lane, Lafayette, IN 47905 | 2011-04-20 |
| 1508164484 | David Thomas Beine | Specialist/Technologist | 1321 Unity Pl Ste A, Lafayette, IN 47905 | 2011-03-02 |
| 1447569538 | Deidre Dudley | Nurse Practitioner | 1701 S Creasy Ln Ste 1w93, Lafayette, IN 47905 | 2010-10-07 |
| 1548493067 | Unity Healthcare, LLC | Podiatrist | 750 Park East Blvd, Unit 4, Lafayette, IN 47905 | 2009-09-01 |
| 1073762969 | Lynette Marie Alexander | Nurse Practitioner | 5500 St Rd. 38 East, Lafayette, IN 47905 | 2008-09-16 |
| Find all providers in zip 47905 | ||||
| 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 |
|---|---|---|---|---|
| 1346868676 | Cypress Bend Oral & Maxillofacial Surgery | Dentist | 106 Rue Bastille, Lafayette, LA 70508 | 2020-07-13 |
| 1578089603 | Ardoin-kennedy LLC | Dentist | 203 A Energy Parkway, Lafayette, LA 70508 | 2017-08-21 |
| 1154864106 | Coal Creek Oral Surgery and Dental Implant Center, Pllc | Dentist | 1771 Cherokee Trl, Lafayette, CO 80026-7088 | 2016-11-23 |
| 1063629988 | Brett A Henrikson | Dentist | 2 Executive Dr Ste A, Lafayette, IN 47905-4859 | 2007-05-17 |
| 1316169030 | Hiram A. Mcconnell | Dentist | 1231 Coolidge Blvd, Lafayette, LA 70503-2620 | 2007-05-03 |
| 1861523441 | Bruce A Schneider | Dentist | 117 Rue Fontaine, Lafayette, LA 70508-5744 | 2007-03-08 |
| 1700976719 | Michael Leonard Bagnoli | Dentist | 2020 Union Street, Suite 200, Lafayette, IN 47904 | 2006-10-13 |
| 1093808594 | Keith R. Gronbach, D.d.s., Inc. | Dentist | 3799 Mt Diablo Blvd, Lafayette, CA 94549-3538 | 2006-10-02 |
| 1104920453 | Christian Matthew Steffey | Dentist | 2020 Union St Ste 200, Lafayette, IN 47904-2694 | 2006-09-08 |
| 1780600031 | Mark Alan Welch | Dentist | 200 Republic Ave, I, Lafayette, LA 70508-6826 | 2006-07-13 |
| Find all providers in LAFAYETTE | ||||
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| 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.