Southern de Associates of Oral & Maxillofacial Surgery

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

2010600241 Issued in DE

Legal business name

SOUTHERN DE ASSOCIATES OF ORAL & MAXILLOFACIAL SURGERY

Practice address

126 West Front St.
Frederica, DE 19946

Phone

(302) 335-2601

Fax

(302) 335-2603

NPI assigned

Feb 5, 2010

Last updated

Feb 5, 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

Allison Kowalchick

Title

Office Manager

Phone

(302) 644-7654

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1265328000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265328000000",
    "number": "1063744795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 266",
            "city": "FREDERICA",
            "state": "DE",
            "postal_code": "199460266",
            "telephone_number": "302-335-2601",
            "fax_number": "302-335-2603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "126 WEST FRONT ST.",
            "city": "FREDERICA",
            "state": "DE",
            "postal_code": "19946",
            "telephone_number": "302-335-2601",
            "fax_number": "302-335-2603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN DE ASSOCIATES OF ORAL & MAXILLOFACIAL SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-05",
        "last_updated": "2010-02-05",
        "status": "A",
        "authorized_official_last_name": "KOWALCHICK",
        "authorized_official_first_name": "ALLISON",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "302-644-7654"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "DE",
            "license": "2010600241",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Oral and Maxillofacial Surgery (Dentist) in Frederica, DE
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 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.