Indiana Oral & Maxillofacial Surgery Associates PC
Organization Active NPI Oral and Maxillofacial Surgery (Dentist) · Fishers, IN
NPI 1407809585 · NPPES record last updated Mar 13, 2026
Key facts
- NPI
- 1407809585
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Oral and Maxillofacial Surgery (Dentist) 1223S0112X
- Legal business name
- INDIANA ORAL & MAXILLOFACIAL SURGERY ASSOCIATES PC
- Practice address
- 10972 Allisonville Rd
Suite 110
Fishers, IN 46038-2637 - Phone
- (317) 913-2363
- Fax
- (317) 913-2370
- NPI assigned
- May 18, 2006
- Organization subpart
- No
Authorized official
- Name
- Keith Miller
- Title
- Administrator
- Phone
- (317) 913-2363
Practitioners 17
-
Jonathan Beker, DMD MD
-
Matthew D Bojrab, D.D.S., M.S.
-
Matthew Miller Davis, D.D.S
-
Natalie Anne Muir Eden, D.D.S.
-
Christopher T. Kirkup, DDS, MS
-
Philip M Montefalco, D.D.S.
-
David M Montes, D.D.S.
-
Tyler J Potter, D.D.S.
-
John W Pruitt, D.D.S., M.D.
-
John Joseph Schier Jr., DMD, MD
-
Samuel Albert Tancredi, D.D.S.
-
Brent Thomas Garrison, D.D.S, M.S.D.
-
Nicholas Kolar, DDS, MD
-
Raymond W. Lee, DDS
-
R. Dale Lentz, D.D.S.
-
Kyley Alan Wood, D.D.S.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20060403000780 | IN | Part B Supplier - Clinic/Group Practice | 9335157254 |
Receives reassigned benefits from 11 practitioners Practice locations: Fishers, IN; Greenwood, IN; Indianapolis, IN; Zionsville, IN |
National Provider Directory
Locations
8102 Kingston St
Ste 400
Avon, IN 46123
Phone (317) 271-7600
1040 Patrick Pl
Ste A
Brownsburg, IN 46112
Phone (317) 297-1007
3021 E 98th St
Ste 250
Carmel, IN 46280
Phone (317) 846-3446
10972 Allisonville Rd
Ste 110
Fishers, IN 46038
Phone (317) 845-7878
10972 Allisonville Rd
Ste 100
Fishers, IN 46038
Phone (317) 845-7878
11980 Fishers Crossing Dr
Fishers, IN 46038
Phone (317) 845-7878
1000 W Jefferson St
Franklin, IN 46131
Phone (317) 736-0607
1630 W Smith Valley Rd
Ste 100
Greenwood, IN 46142
Phone (317) 882-3370
8445 S Emerson Ave
Ste 100
Indianapolis, IN 46237
Phone (317) 882-1284
2647 Waterfront Parkway East Dr
Ste 200
Indianapolis, IN 46214
Phone (317) 297-1007
9670 E Washington St
Ste 235
Indianapolis, IN 46229
Phone (317) 899-5000
8140 Knue Rd
Ste 200
Indianapolis, IN 46250
Phone (317) 849-4914
777 Beachway Dr
Ste 202
Indianapolis, IN 46224
Phone (317) 297-1007
12036 N Michigan Rd
#200
Zionsville, IN 46077
Phone (317) 733-0926
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral and Maxillofacial Surgery (Dentist) |
1223S0112X | Yes |
Addresses
Primary practice location
10972 Allisonville Rd
Suite 110
Fishers, IN 46038-2637
Mailing address
10972 Allisonville Rd
Suite 110
Fishers, IN 46038-2637
Phone (317) 913-2363
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100059140 | Medicaid | IN |
Other names
- Indiana Oral and Maxillofacial Surgery Associates
Other providers in Fishers, IN
- Indiana Anesthesia Solutions LLC
- Indiana Crossroads Community Services
- Indiana Endoscopy Centers LLC
- Indiana Family Care Givers
- Indiana Luna Care Physical Therapy LLC
- Indiana Physician Management-Northeast, LLC
- Indiana Premier Pharmacy
- Indiana Premier Pharmacy
- Indiana Spine Group, PC
- Indiana Spine Group, PC
All providers in Fishers, IN · Oral and Maxillofacial Surgery (Dentist) in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 13, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.