Trevisani Oral Surgery

Primary specialty

Oral and Maxillofacial Surgery Clinic/CenterTaxonomy code 261QS0112X

License

DN13576 Issued in FL

Legal business name

TREVISANI ORAL SURGERY

Practice address

2574 S Volusia Ave
Orange City, FL 32763-9123

Phone

(386) 774-2999

Fax

(386) 774-4922

NPI assigned

Mar 28, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Tammy Eagle

Title

Administrator

Phone

(407) 886-2050

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1332892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332892800000",
    "number": "1053687640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2574 S VOLUSIA AVE",
            "city": "ORANGE CITY",
            "state": "FL",
            "postal_code": "327639123",
            "telephone_number": "386-774-2999",
            "fax_number": "386-774-4922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2574 S VOLUSIA AVE",
            "city": "ORANGE CITY",
            "state": "FL",
            "postal_code": "327639123",
            "telephone_number": "386-774-2999",
            "fax_number": "386-774-4922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TREVISANI ORAL SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-28",
        "last_updated": "2012-03-28",
        "status": "A",
        "authorized_official_last_name": "EAGLE",
        "authorized_official_first_name": "TAMMY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "407-886-2050",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QS0112X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oral and Maxillofacial Surgery",
            "state": "FL",
            "license": "DN13576",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Oral and Maxillofacial Surgery Clinic/Center in Orange City, FL
• Providers in Orange City, FL by specialty
• Oral and Maxillofacial Surgery Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2012; 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.