Gardendale Oral Surgery, P.C.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

GARDENDALE ORAL SURGERY, P.C.

Practice address

919 Sharit Ave Ste 201
Gardendale, AL 35071

Phone

(205) 631-4004

Fax

(205) 631-4007

NPI assigned

Jun 12, 2018

Organization subpart

No

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

Authorized official

Name

Justin D Lackey

Title

Front Office

Phone

(256) 595-2131

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 2

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

• Henry Postlethwaite Robson III, M.D., D.M.D.

  • Oral and Maxillofacial Surgery (Dentist)
  • Cullman, AL
  • NPI 1669434676
  NPD (past)
• Timothy Tracy Obrien, DDS, MD

  • Oral and Maxillofacial Surgery (Dentist)
  • Boise, ID
  • NPI 1487910733
  NPD (past)

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

{
    "created_epoch": "1528761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1530748800000",
    "number": "1336632561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "919 SHARIT AVE STE 201",
            "city": "GARDENDALE",
            "state": "AL",
            "postal_code": "350715008",
            "telephone_number": "205-631-4004",
            "fax_number": "205-631-4007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "919 SHARIT AVE STE 201",
            "city": "GARDENDALE",
            "state": "AL",
            "postal_code": "35071",
            "telephone_number": "205-631-4004",
            "fax_number": "205-631-4007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GARDENDALE ORAL SURGERY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-12",
        "last_updated": "2018-07-05",
        "status": "A",
        "authorized_official_last_name": "LACKEY",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "FRONT OFFICE",
        "authorized_official_telephone_number": "256-595-2131"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "216971",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gardendale Chiropractic Center
• Gardendale Dental
• Gardendale Family Dentistry
• Gardendale Health Mart Pharmacy LLC
• Gardendale Medical Center
• Gardendale Pain and Wellness, LLC
• Gardendale Pharmacy LLC
• Gardendale Physician Associates, P.C.
• Gardendale Surgical Associates
• Gardendale Surgical Associates, LLC

• Oral and Maxillofacial Surgery (Dentist) in Gardendale, AL
• Providers in Gardendale, AL by specialty
• Oral and Maxillofacial Surgery (Dentist) in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 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.