Cardinal Oral & Maxillofacial Surgery Associates

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DN15831 Issued in FL

Legal business name

CARDINAL ORAL & MAXILLOFACIAL SURGERY ASSOCIATES

Practice address

870 Dunlawton Ave
Suite 210
Port Orange, FL 32127-9274

Phone

(386) 756-2580

Fax

(386) 756-2333

NPI assigned

Dec 22, 2016

Last updated

Dec 22, 2016By 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

Sameer N. Hate, DMD, MS

Title

Owner

Phone

(386) 756-2580

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1482364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1482364800000",
    "number": "1114462496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "870 DUNLAWTON AVE",
            "address_2": "SUITE 210",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321279274",
            "telephone_number": "386-756-2580",
            "fax_number": "386-756-2333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "870 DUNLAWTON AVE",
            "address_2": "SUITE 210",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321279274",
            "telephone_number": "386-756-2580",
            "fax_number": "386-756-2333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARDINAL ORAL & MAXILLOFACIAL SURGERY ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-22",
        "last_updated": "2016-12-22",
        "status": "A",
        "authorized_official_last_name": "HATE",
        "authorized_official_first_name": "SAMEER",
        "authorized_official_middle_name": "N.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "386-756-2580",
        "authorized_official_credential": "DMD, MS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "FL",
            "license": "DN15831",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "67275",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Oral and Maxillofacial Surgery (Dentist) in Port Orange, FL
• Providers in Port Orange, FL by specialty
• Oral and Maxillofacial Surgery (Dentist) in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2016; 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.