Mid Ohio Oral Surgery, Inc.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

MID OHIO ORAL SURGERY, INC.

Practice address

4488 W Broad St
Columbus, OH 43228-5610

Phone

(614) 878-7778

Fax

(614) 878-2725

NPI assigned

Dec 28, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Phillip T Latham, D.D.S.NPI 1437215308

Title

President - Surgeon

Phone

61418787778

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Phillip T Latham, D.D.S.

  • Oral and Maxillofacial Surgery (Dentist)
  • Columbus, OH
  • NPI 1437215308
  Authorized official Same address or phone
• John A Cheek, D.D.S.

  • Oral and Maxillofacial Surgery (Dentist)
  • Columbus, OH
  • NPI 1437215316
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1356407258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4488 W BROAD ST",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432285610",
            "telephone_number": "614-878-7778",
            "fax_number": "614-878-2725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4488 W BROAD ST",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432285610",
            "telephone_number": "614-878-7778",
            "fax_number": "614-878-2725"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID OHIO ORAL SURGERY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LATHAM",
        "authorized_official_first_name": "PHILLIP",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "PRESIDENT - SURGEON",
        "authorized_official_telephone_number": "61418787778",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0417758",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Mid Ohio Renal Disease and Hypertension Specialist, Inc.
• Mid Ohio TMS LLC
• Mid Ohio Urology, Inc.

• Oral and Maxillofacial Surgery (Dentist) in Columbus, OH
• Providers in Columbus, OH by specialty
• Oral and Maxillofacial Surgery (Dentist) in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.