Organization · NPI-2
Maxillofacial Surgery Innovative Services
Clinic/Center · Mayfield Heights, OH
NPI number1962929240
StatusActive
Last updated in NPPESJul 21, 2022
Details
- NPI
- 1962929240
- Entity type
- Organization (NPI-2)
- Legal business name
- Maxillofacial Surgery Innovative Services
- Organization subpart
- No
- Enumeration date
- Aug 28, 2017
- Last updated
- Jul 21, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261Q00000X | Clinic/Center | – | – | Yes |
Practice location
1284 Som Center Rd Ste 219Mayfield Heights, OH 44124-2048
Phone 888-774-7773 · Fax 888-774-7970
Mailing address
1284 Som Center Rd Ste 219Mayfield Heights, OH 44124-2048
Phone 888-774-7773 · Fax 888-774-7970
Authorized official
Michelle Ann Hancock
Credentialing Director
5153216451
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