NPIMap

Organization Active NPI

Oral & Maxillofacial Surgeons Inc

  • Oral and Maxillofacial Surgery (Dentist)
  • Toledo, OH
National Provider Identifier
1326030503
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
Legal business name
ORAL & MAXILLOFACIAL SURGEONS INC
Practice address
4646 Nantucket Dr
Suite a
Toledo, OH 43623-3194
Phone
(419) 843-2121
Fax
(419) 517-5104
NPI assigned
Aug 16, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Patrick J McCabe, DDS
Title
President
Phone
(419) 517-2100

Specialties & licenses 1

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

Addresses

Primary practice location

4646 Nantucket Dr
Suite a
Toledo, OH 43623-3194

Mailing address

4646 Nantuckett Dr Ste a
Toledo, OH 43623-3194
Phone (419) 517-2100

Other identifiers 2

IdentifierTypeStateIssuer
2241489MedicaidOH
DB2868OtherOHRR MEDICARE

Other names 1

  • Harbor Light Oral & Maxillofacial Surgeons Inc. Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040205001344 OH Part B Supplier - Clinic/Group Practice 2062305691 Receives reassigned benefits from 1 practitioner
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Toledo, OH; Wauseon, OH; Bowling Green, OH

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory
Tax ID family
Oral Maxillofacial Surg4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

4646 Nantuckett Dr
Ste A
Toledo, OH 43623
Phone (419) 517-2100

725 S Shoop Ave
Ste G1
Wauseon, OH 43567
Phone (419) 517-2100

Practitioners & affiliated clinicians

Practitioners 2

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": "1124150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1326030503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4646 NANTUCKETT DR STE A",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436233194",
            "telephone_number": "419-517-2100",
            "fax_number": "419-517-2105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4646 NANTUCKET DR",
            "address_2": "SUITE A",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436233194",
            "telephone_number": "419-843-2121",
            "fax_number": "419-517-5104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORAL & MAXILLOFACIAL SURGEONS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-16",
        "last_updated": "2022-07-21",
        "certification_date": "2021-07-27",
        "status": "A",
        "authorized_official_last_name": "MCCABE",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "419-517-2100",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "OH",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2241489",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "DB2868",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Harbor Light Oral & Maxillofacial Surgeons Inc.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Toledo, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.