NPIMap

Organization Active NPI

Northwest Oral & Maxillofacial Surgery Associates, P.C.

  • Oral and Maxillofacial Surgery (Dentist)
  • Marietta, GA
National Provider Identifier
1194732735
Registry record updated Jun 22, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
Legal business name
NORTHWEST ORAL & MAXILLOFACIAL SURGERY ASSOCIATES, P.C.
Practice address
55 Whitcher St NE
Suite 140
Marietta, GA 30060-1155
Phone
(770) 422-7630
Fax
(770) 422-6017
NPI assigned
Aug 2, 2006
Last updated
Jun 22, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2015

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

Authorized official

Name
Manuel A. DavilaNPI 1760496210
Title
President
Phone
(770) 422-7630

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193200000X MULTI-SPECIALTY GROUP 1223S0112X Primary

Addresses

Primary practice location

55 Whitcher St NE
Suite 140
Marietta, GA 30060-1155

Mailing address

55 Whitcher St NE
Suite 140
Marietta, GA 30060-1155
Phone (770) 422-7630

National Provider Directory

National Provider Directory

Locations

85 Golf Crest Dr
Ste 209
Acworth, GA 30101
Phone (678) 348-0197

117 First National Dr
Dallas, GA 30157
Phone (770) 505-9100

2176 Macland Rd
Ste A
Dallas, GA 30157
Phone (770) 505-9100

6304 Holly Springs Pkwy
Ste 102
Holly Springs, GA 30188
Phone (770) 516-2759

55 Whitcher St NE
Ste 140
Marietta, GA 30060
Phone (770) 422-7630

5041 Dallas Hwy
Bldg 2A
Powder Springs, GA 30127
Phone (770) 429-5507

345 Parkway 575
Ste 102
Woodstock, GA 30188
Phone (770) 924-1083

Practitioners & affiliated clinicians

Practitioners 8

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": "1154476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1434931200000",
    "number": "1194732735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 WHITCHER ST NE",
            "address_2": "SUITE 140",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601155",
            "telephone_number": "770-422-7630",
            "fax_number": "770-422-6017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 WHITCHER ST NE",
            "address_2": "SUITE 140",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601155",
            "telephone_number": "770-422-7630",
            "fax_number": "770-422-6017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST ORAL & MAXILLOFACIAL SURGERY ASSOCIATES, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-02",
        "last_updated": "2015-06-22",
        "status": "A",
        "authorized_official_last_name": "DAVILA",
        "authorized_official_first_name": "MANUEL",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-422-7630"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2015; 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.