Individual provider Active NPI

Esther Sebum Oh, DDS, MD

  • Oral and Maxillofacial Surgery (Dentist)
  • Gainesville, FL
National Provider Identifier
1124225560
Registry record updated Jan 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
DT588 Issued in FL
Practice address
1600 SW Archer Rd
Department of Oral Maxillofacial Surgery
Gainesville, FL 32610-0416
Phone
(352) 273-6750
Fax
(352) 392-7609
NPI assigned
Jun 29, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2014

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DT588 FL
Oral and Maxillofacial Surgery (Dentist) 1223S0112X DT588 FL Primary
Surgery Physician 208600000X 0101248090 VA

Addresses

Primary practice location

1600 SW Archer Rd
Department of Oral Maxillofacial Surgery
Gainesville, FL 32610-0416

Mailing address

1600 SW Archer Rd
P.O. Box 100416
Gainesville, FL 32610-0416
Phone (352) 273-6750

Other identifiers 1

IdentifierTypeStateIssuer
009159000MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130821000056 FL Practitioner - Oral SurgeryPractitioner - Maxillofacial Surgery 1254574353 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
DT588FLMDDentist
0101248090VAMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Faculty Associates Incorporated Dentist CurrentSince Jun 21, 2013 Accepting new patients

Locations

1600 SW Archer Rd
Gainesville, FL 32610
Phone (352) 265-0077

1600 SW Archer Rd
Rm D26
Gainesville, FL 32610
Phone (352) 273-5380

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1183075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1389312000000",
    "number": "1124225560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 SW ARCHER RD",
            "address_2": "P.O. BOX 100416",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326100416",
            "telephone_number": "352-273-6750",
            "fax_number": "352-392-7609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 SW ARCHER RD",
            "address_2": "DEPARTMENT OF ORAL MAXILLOFACIAL SURGERY",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326100416",
            "telephone_number": "352-273-6750",
            "fax_number": "352-392-7609"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OH",
        "first_name": "ESTHER",
        "middle_name": "SEBUM",
        "name_prefix": "Dr.",
        "credential": "DDS, MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-29",
        "last_updated": "2014-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DT588",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "FL",
            "license": "DT588",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "VA",
            "license": "0101248090",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009159000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gainesville, FL

Sources for this page

Verify at the official NPI Registry.