NPIMap

Organization Active NPI

Great Lakes Oral Surgery, P.C.

  • Oral and Maxillofacial Surgery (Dentist)
  • Fulton, NY
National Provider Identifier
1174858419
Registry record updated Jan 31, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
051594 Issued in NY
Legal business name
GREAT LAKES ORAL SURGERY, P.C.
Practice address
633 W. 3Rd St. S.
Fulton, NY 13069
Phone
(315) 343-6160
Fax
(315) 343-8556
NPI assigned
Oct 5, 2009
Last updated
Jan 31, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2019

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

Authorized official

Name
Dr. David A. Macgregor, DMDNPI 1043425804
Title
Owner
Phone
(315) 343-6160

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X 051594 NY Primary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X NU

Addresses

Primary practice location

633 W. 3Rd St. S.
Fulton, NY 13069

Mailing address

633 W. 3Rd St. S.
Fulton, NY 13069
Phone (315) 343-6160

Other identifiers 1

IdentifierTypeStateIssuer
03118614MedicaidNY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

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": "1254700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548892800000",
    "number": "1174858419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "633 W. 3RD ST. S.",
            "city": "FULTON",
            "state": "NY",
            "postal_code": "13069",
            "telephone_number": "315-343-6160",
            "fax_number": "315-343-8556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "633 W. 3RD ST. S.",
            "city": "FULTON",
            "state": "NY",
            "postal_code": "13069",
            "telephone_number": "315-343-6160",
            "fax_number": "315-343-8556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES ORAL SURGERY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-05",
        "last_updated": "2019-01-31",
        "status": "A",
        "authorized_official_last_name": "MACGREGOR",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "315-343-6160",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NY",
            "license": "051594",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03118614",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fulton, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2019; 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.