Beaches Oral Maxillofacial Surgery, PLLC

Primary specialty

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

Legal business name

BEACHES ORAL MAXILLOFACIAL SURGERY, PLLC

Practice address

472 Jacksonville Dr
Jacksonville Beach, FL 32250-3812

Phone

(904) 246-6545

Fax

(904) 246-3718

NPI assigned

Mar 19, 2024

Organization subpart

No

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

Authorized official

Name

John Landis, DDSNPI 1043453723

Title

Owner

Phone

(904) 246-6545

Specialties & licenses 1

Addresses

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.

• John Frederick Landis, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Jacksonville Beach, FL
  • NPI 1043453723
  NPD Authorized official

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

{
    "created_epoch": "1710806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710806400000",
    "number": "1265292346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "472 JACKSONVILLE DR",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322503812",
            "telephone_number": "904-246-6545",
            "fax_number": "904-246-3718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "472 JACKSONVILLE DR",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322503812",
            "telephone_number": "904-246-6545",
            "fax_number": "904-246-3718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEACHES ORAL MAXILLOFACIAL SURGERY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-19",
        "last_updated": "2024-03-19",
        "certification_date": "2024-03-19",
        "status": "A",
        "authorized_official_last_name": "LANDIS",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-246-6545",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Oral & Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Beaded Star Recovery,LLC

• Oral & Maxillofacial Surgery (D.M.D.) in Jacksonville Beach, FL
• Providers in Jacksonville Beach, FL by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2024; 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.