Maxillofacial Surgery Innovative Services

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

MAXILLOFACIAL SURGERY INNOVATIVE SERVICES

Practice address

1284 Som Center Rd Ste 219
Mayfield Heights, OH 44124-2048

Phone

(888) 774-7773

Fax

(888) 774-7970

NPI assigned

Aug 28, 2017

Last updated

Jul 21, 2022By 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

Michelle Ann Hancock, MS/P, MBA/HCM

Title

Credentialing Director

Phone

(515) 321-6451

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

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.

• Joseph I Krajekian, DMD

  • Oral and Maxillofacial Surgery (Dentist)
  • Mayfield Heights, OH
  • NPI 1891952040
  NPD

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

{
    "created_epoch": "1503878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1962929240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1284 SOM CENTER RD STE 219",
            "city": "MAYFIELD HEIGHTS",
            "state": "OH",
            "postal_code": "441242048",
            "telephone_number": "888-774-7773",
            "fax_number": "888-774-7970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1284 SOM CENTER RD STE 219",
            "city": "MAYFIELD HEIGHTS",
            "state": "OH",
            "postal_code": "441242048",
            "telephone_number": "888-774-7773",
            "fax_number": "888-774-7970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAXILLOFACIAL SURGERY INNOVATIVE SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-28",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "HANCOCK",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "CREDENTIALING DIRECTOR",
        "authorized_official_telephone_number": "515-321-6451",
        "authorized_official_credential": "MS/P, MBA/HCM"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2855503",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica Matsko, PHARMD
• Matthew Hudzinski DMD LLC
• Deirdre J Mattina, MD
• Sara Mauk, CNP
• Margaret Lynn Mauler, CNP
• Mayfield Heights City (City of Mayfield Heights)
• Mayfield Heights Healthcare LLC
• Lindsay A Mayher, LPN
• Callie Nichole Maynard, PHARMD
• Bianca Mayzel, PHARMD

• Clinic/Center in Mayfield Heights, OH
• Providers in Mayfield Heights, OH by specialty
• Clinic/Center in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.