Provider Demographics
NPI:1770973281
Name:AMBULATORY ANESTHESIA GROUP, INC.
Entity type:Organization
Organization Name:AMBULATORY ANESTHESIA GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTORY
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:ROGER
Authorized Official - Last Name:FLESER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:800-222-8207
Mailing Address - Street 1:1530 N STATE ROUTE 61
Mailing Address - Street 2:
Mailing Address - City:SUNBURY
Mailing Address - State:OH
Mailing Address - Zip Code:43074-9509
Mailing Address - Country:US
Mailing Address - Phone:800-222-8207
Mailing Address - Fax:740-965-9560
Practice Address - Street 1:1530 N STATE ROUTE 61
Practice Address - Street 2:
Practice Address - City:SUNBURY
Practice Address - State:OH
Practice Address - Zip Code:43074-9509
Practice Address - Country:US
Practice Address - Phone:800-222-8207
Practice Address - Fax:740-965-9560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-04
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300187561223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0004XDental ProvidersDentistDental AnesthesiologyGroup - Single Specialty