NPIMap

Organization Active NPI

Fishers Oral & Maxillofacial Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Fishers, IN
National Provider Identifier
1174534515
Registry record updated Oct 29, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
12007758 Issued in IN
Legal business name
FISHERS ORAL & MAXILLOFACIAL SURGERY
Practice address
9126 Technology LN
Ste 300
Fishers, IN 46038-3064
Phone
(317) 849-3667
Fax
(317) 849-3668
NPI assigned
Aug 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2012

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

Authorized official

Name
Dr. Michael D Bennett, DDSNPI 1639217060
Title
President Surgeon
Phone
(317) 849-3667

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X SINGLE SPECIALTY GROUP 1223S0112X 12007758 IN Primary

Addresses

Primary practice location

9126 Technology LN
Ste 300
Fishers, IN 46038-3064

Mailing address

9126 Technology LN
Ste 300
Fishers, IN 46038-3064
Phone (317) 849-3667

National Provider Directory

National Provider Directory

Locations

9126 Technology Ln
Ste 300
Fishers, IN 46038
Phone (317) 849-3667

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351468800000",
    "number": "1174534515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9126 TECHNOLOGY LN",
            "address_2": "STE 300",
            "city": "FISHERS",
            "state": "IN",
            "postal_code": "460383064",
            "telephone_number": "317-849-3667",
            "fax_number": "317-849-3668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9126 TECHNOLOGY LN",
            "address_2": "STE 300",
            "city": "FISHERS",
            "state": "IN",
            "postal_code": "460383064",
            "telephone_number": "317-849-3667",
            "fax_number": "317-849-3668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FISHERS ORAL & MAXILLOFACIAL SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-10",
        "last_updated": "2012-10-29",
        "status": "A",
        "authorized_official_last_name": "BENNETT",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT SURGEON",
        "authorized_official_telephone_number": "317-849-3667",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IN",
            "license": "12007758",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fishers, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 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.