MIDWEST ORAL AND MAXILLOFACIAL SURGERY P C
NPI 1467507798
Dentist - Oral and Maxillofacial Surgery in Columbia City, IN

Q: What is Midwest Oral And Maxillofacial Surgery P C's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Surgery, with taxonomy code 1223S0112X.

Active since January 25, 2007

516 N LINE ST, COLUMBIA CITY, IN 46725(260) 244-4007 Get Directions Write a Review

NPPES record last updated: March 26, 2009. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Midwest Oral And Maxillofacial Surgery P C NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MIDWEST ORAL AND MAXILLOFACIAL SURGERY P C (NPI 1467507798) is a healthcare organization registered as an oral and maxillofacial surgery in Columbia City, Indiana and active in the NPI registry since January 2007. The organization lists Michael L Iczkovitz, President, as its authorized official.

NPPES Registry Identity

NPI1467507798

Entity TypeOrganization

Primary Taxonomy1223S0112X

Legal Business NameMIDWEST ORAL AND MAXILLOFACIAL SURGERY P C

Location Address516 N LINE STColumbia City, IN 46725-1230

Mailing Address3303 Trier RdFort Wayne, IN 46815-4768 · (260) 484-9990 · Fax (260) 484-6573

Phone(260) 244-4007

Organization SubpartNo

Authorized OfficialMichael L IczkovitzPresident · (260) 484-9990

Enumeration DateJanuary 25, 2007

Last NPPES UpdateMarch 26, 2009

✔ NPI 1467507798 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Oral and Maxillofacial SurgeryDental Providers

Taxonomy Code1223S0112X

License✔ Licensed in IN · 54000677

Definition

An oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.

516 N LINE ST, Columbia City, IN 46725

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Other Identifiers 2

Medicaid200147450IN

Medicare ID-Type Unspecified924690IN · Medicare

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Midwest Oral And Maxillofacial Surgery P C's NPI number?

The NPI number for Midwest Oral And Maxillofacial Surgery P C is 1467507798. It was assigned to this organization in the NPPES registry on January 25, 2007.

Where is Midwest Oral And Maxillofacial Surgery P C located?

Midwest Oral And Maxillofacial Surgery P C is located at 516 N Line St, Columbia City, IN 46725. The listed phone number is (260) 244-4007.

What is Midwest Oral And Maxillofacial Surgery P C's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Surgery, with taxonomy code 1223S0112X.

When was this NPI record last updated?

The NPPES record for Midwest Oral And Maxillofacial Surgery P C was last updated on March 26, 2009. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.