Provider Demographics
NPI:1316999493
Name:MIDWEST ORAL & MAXILLOFACIAL SURGERY, P.C.
Entity type:Organization
Organization Name:MIDWEST ORAL & MAXILLOFACIAL SURGERY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL SURGEON/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:MCDERMOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-397-7777
Mailing Address - Street 1:14625 CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-1950
Mailing Address - Country:US
Mailing Address - Phone:402-397-7777
Mailing Address - Fax:402-390-9336
Practice Address - Street 1:14625 CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-1950
Practice Address - Country:US
Practice Address - Phone:402-397-7777
Practice Address - Fax:402-390-9336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
099487Medicare PIN