Avie Oral Surgery Group

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

14775 Issued in MD

Legal business name

AVIE ORAL SURGERY GROUP

Practice address

1215 Annapolis Rd
Suite 205
Odenton, MD 21113-1344

Phone

(678) 982-5136

NPI assigned

Jul 17, 2016

Last updated

Feb 15, 2023By 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. Edna BuckleNPI 1346533627

Title

President

Phone

(678) 982-5136

Specialties & licenses 2

Addresses

Locations

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.

• Edna Buckle, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Odenton, MD
  • NPI 1346533627
  NPD Authorized official

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

{
    "created_epoch": "1468713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1676419200000",
    "number": "1013360858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1215 ANNAPOLIS RD STE 205",
            "city": "ODENTON",
            "state": "MD",
            "postal_code": "211131346",
            "telephone_number": "678-982-5136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1215 ANNAPOLIS RD",
            "address_2": "SUITE 205",
            "city": "ODENTON",
            "state": "MD",
            "postal_code": "211131344",
            "telephone_number": "678-982-5136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVIE ORAL SURGERY GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-17",
        "last_updated": "2023-02-15",
        "certification_date": "2023-02-15",
        "status": "A",
        "authorized_official_last_name": "BUCKLE",
        "authorized_official_first_name": "EDNA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "678-982-5136",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MD",
            "license": "14775",
            "primary": true
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Oral and Maxillofacial Surgery (Dentist) in Odenton, MD
• Providers in Odenton, MD by specialty
• Oral and Maxillofacial Surgery (Dentist) in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2023; 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.