NPIMap

Organization Active NPI

Oral & Maxillofacial Surgery Associates PA

  • Oral and Maxillofacial Surgery (Dentist)
  • Durham, NC
National Provider Identifier
1356349591
Registry record updated Feb 6, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
5471 Issued in NC
Legal business name
ORAL & MAXILLOFACIAL SURGERY ASSOCIATES PA
Practice address
2823 N Duke St
Durham, NC 27704-2621
Phone
(919) 479-0707
Fax
(919) 479-5435
NPI assigned
Jul 12, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2018

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

Authorized official

Name
Becky Coley
Title
Administrative Supervisor
Phone
(919) 479-0707

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223S0112X 3213 NC
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223S0112X 4783 NC
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223S0112X 4344 NC
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223S0112X 5471 NC Primary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223S0112X 9600058 NC

Addresses

Primary practice location

2823 N Duke St
Durham, NC 27704-2621

Mailing address

2823 N Duke St
Durham, NC 27704-2621
Phone (919) 479-0707

Other identifiers 2

IdentifierTypeStateIssuer
8902006MedicaidNC
02006OtherNCBCBS GROUP ID

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050427001159 NC Part B Supplier - Clinic/Group Practice 6002855244 Receives reassigned benefits from 5 practitioners
Practice locations: Sanford, NC; Durham, NC; Chapel Hill, NC

National Provider Directory

National Provider Directory

Locations

501 Eastowne Dr
Ste 110
Chapel Hill, NC 27514
Phone (919) 929-2196

2823 N Duke St
Durham, NC 27704
Phone (919) 479-0707

109 Dennis Dr
Sanford, NC 27330
Phone (919) 775-1615

Practitioners & affiliated clinicians

Practitioners 9

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": "1121126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1517875200000",
    "number": "1356349591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2823 N DUKE ST",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277042621",
            "telephone_number": "919-479-0707",
            "fax_number": "919-479-5435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2823 N DUKE ST",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277042621",
            "telephone_number": "919-479-0707",
            "fax_number": "919-479-5435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORAL & MAXILLOFACIAL SURGERY ASSOCIATES PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-12",
        "last_updated": "2018-02-06",
        "status": "A",
        "authorized_official_last_name": "COLEY",
        "authorized_official_first_name": "BECKY",
        "authorized_official_title_or_position": "ADMINISTRATIVE SUPERVISOR",
        "authorized_official_telephone_number": "919-479-0707"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NC",
            "license": "3213",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NC",
            "license": "4783",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NC",
            "license": "4344",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NC",
            "license": "5471",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NC",
            "license": "9600058",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8902006",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP ID",
            "identifier": "02006",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Durham, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2018; 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.