East Central Indiana Oral and Maxillofacial Surgery, LLC

Primary specialty

Oral and Maxillofacial Surgery Clinic/CenterTaxonomy code 261QS0112X

License

12008702A Issued in IN

Legal business name

EAST CENTRAL INDIANA ORAL AND MAXILLOFACIAL SURGERY, LLC

Practice address

3895 N Wheeling Ave
Muncie, IN 47304-1776

Phone

(765) 281-1131

NPI assigned

Oct 10, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Harry Papadopoulos, DDS, MD

Title

Practice Co-Owner

Phone

(765) 281-1131

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1349827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349827200000",
    "number": "1720330004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3895 N WHEELING AVE",
            "city": "MUNCIE",
            "state": "IN",
            "postal_code": "473041776",
            "telephone_number": "765-281-1131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3895 N WHEELING AVE",
            "city": "MUNCIE",
            "state": "IN",
            "postal_code": "473041776",
            "telephone_number": "765-281-1131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST CENTRAL INDIANA ORAL AND MAXILLOFACIAL SURGERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-10",
        "last_updated": "2012-10-10",
        "status": "A",
        "authorized_official_last_name": "PAPADOPOULOS",
        "authorized_official_first_name": "HARRY",
        "authorized_official_title_or_position": "PRACTICE CO-OWNER",
        "authorized_official_telephone_number": "765-281-1131",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, MD"
    },
    "taxonomies": [
        {
            "code": "261QS0112X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oral and Maxillofacial Surgery",
            "state": "IN",
            "license": "12010966A",
            "primary": false
        },
        {
            "code": "261QS0112X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oral and Maxillofacial Surgery",
            "state": "IN",
            "license": "12008702A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lauren Dybwad
• Dycora Transitional Health - Muncie LLC
• Briana Lynn Dykstra, OTR
• Alice Dyson, CCC/SLP
• Elizabeth Joan Earl
• East Central Indiana Pathologists PC
• East Central Indiana Primary Care Network
• East Central Indiana Vascular Lab LLC
• East Central Radiology
• Eastern Indiana Neurology, P.C.

• Oral and Maxillofacial Surgery Clinic/Center in Muncie, IN
• Providers in Muncie, IN by specialty
• Oral and Maxillofacial Surgery Clinic/Center in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2012; 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.