Provider Demographics
NPI:1194960328
Name:CINCINNATI ORAL & MAXILLOFACIAL SURG. INC.
Entity type:Organization
Organization Name:CINCINNATI ORAL & MAXILLOFACIAL SURG. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:T
Authorized Official - Last Name:BELPERIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-451-7300
Mailing Address - Street 1:2852 BOUDINOT AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45238
Mailing Address - Country:US
Mailing Address - Phone:513-451-7300
Mailing Address - Fax:513-347-2382
Practice Address - Street 1:2852 BOUDINOT AVE
Practice Address - Street 2:
Practice Address - City:CINTI
Practice Address - State:OH
Practice Address - Zip Code:45238
Practice Address - Country:US
Practice Address - Phone:513-451-7300
Practice Address - Fax:513-347-2382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH160691223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHHA0654901Medicare PIN
OHW41885Medicare UPIN