NPIMap

Organization Active NPI

Southern Maryland Oral & Maxillofacial Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Waldorf, MD
National Provider Identifier
1174559298
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
5594 Issued in MD
Legal business name
SOUTHERN MARYLAND ORAL & MAXILLOFACIAL SURGERY
Practice address
3450 Old Washington Rd
Suite 201
Waldorf, MD 20602-3248
Phone
(301) 645-6911
Fax
(301) 843-0083
NPI assigned
Jun 23, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. John J Heffron, D.D.S.NPI 1659353423
Title
President
Phone
(301) 807-3230

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) 1223S0112X 5594 MD Primary

Addresses

Primary practice location

3450 Old Washington Rd
Suite 201
Waldorf, MD 20602-3248

Mailing address

3450 Old Washington Rd
Suite 201
Waldorf, MD 20602-3248
Phone (301) 645-6911

National Provider Directory

National Provider Directory

Locations

22888 Three Notch Rd
Ste 101
California, MD 20619

3450 Old Washington Rd
Ste 201
Waldorf, MD 20602
Phone (301) 645-6911

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1151020800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1174559298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3450 OLD WASHINGTON RD",
            "address_2": "SUITE 201",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206023248",
            "telephone_number": "301-645-6911",
            "fax_number": "301-843-0083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3450 OLD WASHINGTON RD",
            "address_2": "SUITE 201",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206023248",
            "telephone_number": "301-645-6911",
            "fax_number": "301-843-0083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN MARYLAND ORAL & MAXILLOFACIAL SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HEFFRON",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "301-807-3230",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MD",
            "license": "5594",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waldorf, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.