Provider Demographics
NPI:1427471382
Name:ORAL & MAXILLOFACIAL SURGERY CLINIC INC.
Entity type:Organization
Organization Name:ORAL & MAXILLOFACIAL SURGERY CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:
Authorized Official - Last Name:FORDJOUR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:901-526-3988
Mailing Address - Street 1:910 MADISON AVE STE 710
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-3453
Mailing Address - Country:US
Mailing Address - Phone:901-526-3988
Mailing Address - Fax:901-526-9807
Practice Address - Street 1:910 MADISON AVE STE 710
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-3453
Practice Address - Country:US
Practice Address - Phone:901-526-3988
Practice Address - Fax:901-526-9807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-29
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty