South Bedford Oral & Maxillofacial Surgery PLLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

051590 Issued in NY

Legal business name

SOUTH BEDFORD ORAL & MAXILLOFACIAL SURGERY PLLC

Practice address

105 South Bedford Road
Suite 330
Mt. Kisco, NY 10549-3466

Phone

(914) 242-1142

Fax

(914) 242-1147

NPI assigned

Jun 9, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Jason Baker, DMD

Title

Owner

Phone

(914) 242-1142

Specialties & licenses 3

Addresses

Locations

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

{
    "created_epoch": "1244505600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1486512000000",
    "number": "1275769929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 SOUTH BEDFORD ROAD",
            "address_2": "SUITE 330",
            "city": "MT. KISCO",
            "state": "NY",
            "postal_code": "105493466",
            "telephone_number": "914-242-1142",
            "fax_number": "914-242-1147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 SOUTH BEDFORD ROAD",
            "address_2": "SUITE 330",
            "city": "MT. KISCO",
            "state": "NY",
            "postal_code": "105493466",
            "telephone_number": "914-242-1142",
            "fax_number": "914-242-1147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH BEDFORD ORAL & MAXILLOFACIAL SURGERY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-09",
        "last_updated": "2017-02-08",
        "status": "A",
        "authorized_official_last_name": "BAKER",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "914-242-1142",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NY",
            "license": "051590",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NY",
            "license": "052234",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NY",
            "license": "049711",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Oral and Maxillofacial Surgery (Dentist) in Mount Kisco, NY
• Providers in Mount Kisco, NY by specialty
• Oral and Maxillofacial Surgery (Dentist) in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2017; 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.