NPIMap

Organization Active NPI

Face and Jaw Surgeons PC

  • Oral and Maxillofacial Surgery (Dentist)
  • Fargo, ND
National Provider Identifier
1295804300
Registry record updated Jun 8, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
Legal business name
FACE AND JAW SURGEONS PC
Practice address
4344 20TH Ave S
Ste 2
Fargo, ND 58103-7436
Phone
(701) 239-5969
Fax
(701) 239-0034
NPI assigned
Nov 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2017

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

Authorized official

Name
Scott A Preisler, DDS MS
Title
DDS Ms
Phone
(701) 239-5969

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223S0112X Primary

Addresses

Primary practice location

4344 20TH Ave S
Ste 2
Fargo, ND 58103-7436

Mailing address

4344 20TH Ave S
Ste 2
Fargo, ND 58103-7436
Phone (701) 239-5969

Other identifiers 1

IdentifierTypeStateIssuer
41329MedicaidND

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040514000837 ND Part B Supplier - Clinic/Group Practice 1153311881 Receives reassigned benefits from 14 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Jamestown, ND; Dickinson, ND; Grand Forks, ND; Bismarck, ND; Fargo, ND

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Face and Jaw Surgeons PC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4344 20th Ave S
Ste 2
Fargo, ND 58103
Phone (701) 239-5969

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1496880000000",
    "number": "1295804300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4344 20TH AVE S",
            "address_2": "STE 2",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581037436",
            "telephone_number": "701-239-5969",
            "fax_number": "701-239-0034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4344 20TH AVE S",
            "address_2": "STE 2",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581037436",
            "telephone_number": "701-239-5969",
            "fax_number": "701-239-0034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FACE AND JAW SURGEONS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-06",
        "last_updated": "2017-06-08",
        "status": "A",
        "authorized_official_last_name": "PREISLER",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "DDS MS",
        "authorized_official_telephone_number": "701-239-5969",
        "authorized_official_credential": "DDS MS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41329",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fargo, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.