| Blue Ash Oral And Maxillofacial Surgery, Inc | |
|
4350 Malsbary Rd Suite 201 Cincinnati OH 45242-5621 | |
| (513) 984-2100 | |
| (513) 984-2155 |
| Full Name | Blue Ash Oral And Maxillofacial Surgery, Inc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 4350 Malsbary Rd, Cincinnati, Ohio |
| Authorized Official Name and Position | Randall David Stastny (OWNER) |
| Authorized Official Contact | 5139842100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Blue Ash Oral And Maxillofacial Surgery, Inc 4350 Malsbary Rd Suite 201 Cincinnati OH 45242-5621 Ph: (513) 984-2100 | Blue Ash Oral And Maxillofacial Surgery, Inc 4350 Malsbary Rd Suite 201 Cincinnati OH 45242-5621 Ph: (513) 984-2100 |
| NPI Number | 1588759609 |
|---|---|
| Provider Enumeration Date | 10/04/2006 |
| Last Update Date | 03/04/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588759609 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 30-1-8892 (Ohio) | Primary |
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