| Indiana Oral & Maxillofacial Surgery Associates Pc | |
|
10972 Allisonville Rd Suite 110 Fishers IN 46038-2637 | |
| (317) 913-2363 | |
| (317) 913-2370 |
| Full Name | Indiana Oral & Maxillofacial Surgery Associates Pc |
|---|---|
| Speciality | Dentist |
| Location | 10972 Allisonville Rd, Fishers, Indiana |
| Authorized Official Name and Position | Keith Miller (ADMINISTRATOR) |
| Authorized Official Contact | 3179132363 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Indiana Oral & Maxillofacial Surgery Associates Pc 10972 Allisonville Rd Suite 110 Fishers IN 46038-2637 Ph: (317) 913-2363 | Indiana Oral & Maxillofacial Surgery Associates Pc 10972 Allisonville Rd Suite 110 Fishers IN 46038-2637 Ph: (317) 913-2363 |
| NPI Number | 1407809585 |
|---|---|
| Provider Enumeration Date | 05/18/2006 |
| Last Update Date | 04/14/2017 |
| Medicare PECOS PAC ID | 9335157254 |
|---|---|
| Medicare Enrollment ID | O20060403000780 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407809585 | NPI | - | NPPES |
| 100059140 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
| Provider Name | Christopher Todd Kirkup |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1497787220 PECOS PAC ID: 0446257315 Enrollment ID: I20061107000366 |
| Provider Name | Matthew D Bojrab |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1043308968 PECOS PAC ID: 4284636069 Enrollment ID: I20070207000342 |
| Provider Name | Samuel A Tancredi |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1073783478 PECOS PAC ID: 5395818942 Enrollment ID: I20080716000050 |
| Provider Name | Philip M Montefalco |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1437103017 PECOS PAC ID: 7315944287 Enrollment ID: I20100812000100 |
| Provider Name | John E Moenning |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1598702789 PECOS PAC ID: 6406853373 Enrollment ID: I20100812000126 |
| Provider Name | Tyler J Potter |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1992749402 PECOS PAC ID: 8224035191 Enrollment ID: I20100812000888 |
| Provider Name | John W Adelsperger |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1588667448 PECOS PAC ID: 2961409826 Enrollment ID: I20100812000921 |
| Provider Name | John W Pruitt |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1821045147 PECOS PAC ID: 9133126006 Enrollment ID: I20100820000682 |
| Provider Name | Michael G Kapp |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1215977368 PECOS PAC ID: 2860499720 Enrollment ID: I20100820000719 |
| Provider Name | John Jeffrey Hockema |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1033112099 PECOS PAC ID: 0042217903 Enrollment ID: I20100820000992 |
| Provider Name | David M Montes |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1407952609 PECOS PAC ID: 8426133836 Enrollment ID: I20131120001187 |
| Provider Name | Matthew M Davis |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1740417898 PECOS PAC ID: 0345489928 Enrollment ID: I20140319001317 |
| Provider Name | Natalie M Eden |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1316179658 PECOS PAC ID: 6103066774 Enrollment ID: I20140625001060 |
| Provider Name | Robert C Lambert |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1801184163 PECOS PAC ID: 8224277900 Enrollment ID: I20151125000092 |
| Provider Name | John Joseph Schier |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1932440054 PECOS PAC ID: 4789927716 Enrollment ID: I20190515001279 |
| Provider Name | Jonathan Beker |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1407389802 PECOS PAC ID: 7416365473 Enrollment ID: I20240308002664 |
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