Greenville Oral Maxillofacial Surgery, P.a., a South Carolina Professi

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

Legal business name

GREENVILLE ORAL MAXILLOFACIAL SURGERY, P.A., A SOUTH CAROLINA PROFESSI

Doing business as

Summerville Oral Surgery

Practice address

403 W 4TH North St Unit a
Summerville, SC 29483-6552

Phone

(843) 821-7583

NPI assigned

Jul 24, 2025

Last updated

Jul 24, 2025By the provider in NPPES

Organization subpart

Yes

Parent organization

GREENVILLE ORAL MAXILLOFACIAL SURGERY, P.A., A SOUTH CAROLINA PROFESSIAs reported in NPPES

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

Authorized official

Name

Tina A Hicks

Title

Billing

Phone

(864) 216-7924

Specialties & licenses 1

Addresses

Other names 1

• Summerville Oral Surgery Doing business as

Tax ID family

Greenville Oral Maxillofacial Surgery PA a South Carolina Professi3 organizations share this tax ID, including this one

Part of

Greenville Oral Maxillofacial Surgery PA a South Carolina Professi

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Greenville Oral Maxillofacial Surgery, P.a., a South Carolina Professi

  dba Greenville Oral Surgery Partners

  • Oral and Maxillofacial Surgery (Dentist)
  • Greenville, SC
  • NPI 1619008547
  NPD tax ID
• River Falls Oral Surgery

  • Oral and Maxillofacial Pathology Dentistry
  • Duncan, SC
  • NPI 1174656540
  NPD tax ID

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Greenville Oral Maxillofacial Surgery, P.a., a South Carolina Professi

  dba Greenville Oral Surgery Partners

  • Oral and Maxillofacial Surgery (Dentist)
  • Greenville, SC
  • NPI 1619008547
  NPPES parent name

Practitioners 1

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.

• Tina Tran

  • Oral and Maxillofacial Surgery (Dentist)
  • Summerville, SC
  • NPI 1093341000
  NPD (past)

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

{
    "created_epoch": "1753315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753315200000",
    "number": "1184506693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "403 W 4TH NORTH ST UNIT A",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294836552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "403 W 4TH NORTH ST UNIT A",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294836552",
            "telephone_number": "843-821-7583"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENVILLE ORAL MAXILLOFACIAL SURGERY, P.A., A SOUTH CAROLINA PROFESSI",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GREENVILLE ORAL MAXILLOFACIAL SURGERY, P.A., A SOUTH CAROLINA PROFESSI",
        "enumeration_date": "2025-07-24",
        "last_updated": "2025-07-24",
        "certification_date": "2025-07-24",
        "status": "A",
        "authorized_official_last_name": "HICKS",
        "authorized_official_first_name": "TINA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "BILLING",
        "authorized_official_telephone_number": "864-216-7924"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Summerville Oral Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Shameka J Green
• Tamara M Green, MSPT
• Taylor Wharton Green
• Brandi L Greene, PTA
• Dana Monique Greene
• Amanda Anderson Gregory, DMD
• Grey Dove Counseling
• Griffin Dental, PA
• Kent Griffin, D.D.S
• Sarah P Griffin, CCC-SLP

• Oral & Maxillofacial Surgery (D.M.D.) in Summerville, SC
• Providers in Summerville, SC by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2025; 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.