Mission Valley Oral & Maxillofacial Surgery, Inc.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

31922 Issued in CA

Legal business name

MISSION VALLEY ORAL & MAXILLOFACIAL SURGERY, INC.

Practice address

2878 Camino del Rio S
Suite 210
San Diego, CA 92108-3872

Phone

(619) 298-2200

Fax

(619) 298-2250

NPI assigned

Oct 2, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Frederick White Hammond, DDS

Title

Partner

Phone

(619) 298-2200

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1254441600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1254441600000",
    "number": "1265767644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2878 CAMINO DEL RIO S",
            "address_2": "SUITE 210",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921083872",
            "telephone_number": "619-298-2200",
            "fax_number": "619-298-2250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2878 CAMINO DEL RIO S",
            "address_2": "SUITE 210",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921083872",
            "telephone_number": "619-298-2200",
            "fax_number": "619-298-2250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSION VALLEY ORAL & MAXILLOFACIAL SURGERY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-02",
        "last_updated": "2009-10-02",
        "status": "A",
        "authorized_official_last_name": "HAMMOND",
        "authorized_official_first_name": "FREDERICK",
        "authorized_official_middle_name": "WHITE",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "619-298-2200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "31922",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Anisha Mistry
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• Loretta I. Mitch-Lynn, N.P.
• Alexis Mitchell

• Oral and Maxillofacial Surgery (Dentist) in San Diego, CA
• Providers in San Diego, CA by specialty
• Oral and Maxillofacial Surgery (Dentist) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2009; 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.