NPIMap

Organization Active NPI

Citrus Oral and Facial Surgery at Ocala, LLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Crystal River, FL
National Provider Identifier
1326535279
Registry record updated Jun 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
DN17708 Issued in FL
Legal business name
CITRUS ORAL AND FACIAL SURGERY AT OCALA, LLC
Practice address
6129 W Corporate Oaks Dr
Crystal River, FL 34429-8732
Phone
(352) 795-4994
Fax
(352) 795-4609
NPI assigned
Apr 17, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2023

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

Authorized official

Name
Mrs. Misty C Blomberg
Title
Office Manager
Phone
(522) 509-6500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X SINGLE SPECIALTY GROUP 1223S0112X DN17708 FL Primary

Addresses

Primary practice location

6129 W Corporate Oaks Dr
Crystal River, FL 34429-8732

Mailing address

2611 SE 17TH St Ste a
Ocala, FL 34471-5587
Phone (352) 509-6500

National Provider Directory

National Provider Directory

Locations

2611 SE 17th St
Ste A
Ocala, FL 34471
Phone (352) 509-6500

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1523923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687305600000",
    "number": "1326535279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2611 SE 17TH ST STE A",
            "city": "OCALA",
            "state": "FL",
            "postal_code": "344715587",
            "telephone_number": "352-509-6500",
            "fax_number": "352-509-6556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6129 W CORPORATE OAKS DR",
            "city": "CRYSTAL RIVER",
            "state": "FL",
            "postal_code": "344298732",
            "telephone_number": "352-795-4994",
            "fax_number": "352-795-4609"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITRUS ORAL AND FACIAL SURGERY AT OCALA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-17",
        "last_updated": "2023-06-21",
        "certification_date": "2023-06-21",
        "status": "A",
        "authorized_official_last_name": "BLOMBERG",
        "authorized_official_first_name": "MISTY",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "522-509-6500",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "FL",
            "license": "DN17708",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crystal River, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2023; 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.