Bulloch Oral and Maxillofacial Surgery and Dental Implant Center

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DN013413 Issued in GA

Legal business name

BULLOCH ORAL AND MAXILLOFACIAL SURGERY AND DENTAL IMPLANT CENTER

Practice address

301 Florence Ave
Statesboro, GA 30458-5138

Phone

(912) 764-7500

Fax

(912) 764-7503

NPI assigned

May 12, 2010

Last updated

May 12, 2010By 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

Dr. Roger Lee Myers, DMD

Title

Owner

Phone

(912) 764-7500

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1273622400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1273622400000",
    "number": "1013235290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 FLORENCE AVE",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304585138",
            "telephone_number": "912-764-7500",
            "fax_number": "912-764-7503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 FLORENCE AVE",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304585138",
            "telephone_number": "912-764-7500",
            "fax_number": "912-764-7503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BULLOCH ORAL AND MAXILLOFACIAL SURGERY AND DENTAL IMPLANT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-12",
        "last_updated": "2010-05-12",
        "status": "A",
        "authorized_official_last_name": "MYERS",
        "authorized_official_first_name": "ROGER",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "912-764-7500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "GA",
            "license": "DN013413",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "379753056C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bulloch County Health Care LLC (Heritage Inn Health and Rehabilitation)
• Bulloch County LTC LLC (Eagle Health and Rehabilitation)
• Bulloch County LTC, LLC (Eagle Health & Rehabilitation)
• Bulloch County LTC, LLC (Eagle Health & Rehabilitation)
• Bulloch Family Practice
• Bulloch Oral and Maxillofacial Surgery and Dental Implant Center
• Bulloch Pediatrics Group, LLC
• Bulloch Pediatrics, PC
• Bulloch Recovery Resources
• Burke Hospital Company (Southeastern Spine and Pain)

• Oral and Maxillofacial Surgery (Dentist) in Statesboro, GA
• Providers in Statesboro, GA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2010; 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.