Advanced Oral Surgery

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

ADVANCED ORAL SURGERY

Practice address

19925 Idealic Ave
Lakeville, MN 55044-2003

Phone

(507) 327-9574

NPI assigned

Sep 13, 2018

Last updated

Sep 13, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jonathan McCabe, DMD, MDNPI 1023307113

Title

Oral & Maxillofacial Surgeon

Phone

(507) 327-9574

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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.

• Jonathan Colin McCabe, MD, DMD

  • Student in an Organized Health Care Education/Training Program
  • Mankato, MN
  • NPI 1023307113

  Oral and Maxillofacial Surgery

  NPD (past) Authorized official

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

{
    "created_epoch": "1536796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1536796800000",
    "number": "1295218303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19318 IMPALA AVE",
            "city": "LAKEVILLE",
            "state": "MN",
            "postal_code": "550441600",
            "telephone_number": "507-327-9574"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19925 IDEALIC AVE",
            "city": "LAKEVILLE",
            "state": "MN",
            "postal_code": "550442003",
            "telephone_number": "507-327-9574"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED ORAL SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-13",
        "last_updated": "2018-09-13",
        "status": "A",
        "authorized_official_last_name": "MCCABE",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "ORAL & MAXILLOFACIAL SURGEON",
        "authorized_official_telephone_number": "507-327-9574",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD, MD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1023307113",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Oral and Maxillofacial Surgery (Dentist) in Lakeville, MN
• Providers in Lakeville, MN by specialty
• Oral and Maxillofacial Surgery (Dentist) in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2018; 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.