First Coast Oral & Facial Surgery, PA

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

Legal business name

FIRST COAST ORAL & FACIAL SURGERY, PA

Practice address

319 W Town Place
Suite 2
St Augustine, FL 32092

Phone

(904) 529-8889

NPI assigned

May 24, 2012

Last updated

May 24, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Thomas E Stakem, D.D.S., M.D.NPI 1932259405

Title

President

Phone

(904) 529-8889

Specialties & licenses 1

Addresses

Locations

Practitioners 2

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.

• Thomas E Stakem, D.D.S.,M.D.

  • Oral and Maxillofacial Surgery (Dentist)
  • Green Cove Springs, FL
  • NPI 1932259405
  Authorized official Same address or phone
• Charles D Milton Jr., D.D.S., M.D.

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Yulee, FL
  • NPI 1811107253
  NPD (past)

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

{
    "created_epoch": "1337817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337817600000",
    "number": "1356601249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "319 WEST TOWN PLACE #2",
            "city": "ST. AUGUSTINE",
            "state": "FL",
            "postal_code": "32092",
            "telephone_number": "904-529-8889",
            "fax_number": "904-529-8893"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "319 W TOWN PLACE",
            "address_2": "SUITE 2",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "32092",
            "telephone_number": "904-529-8889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIRST COAST ORAL & FACIAL SURGERY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-24",
        "last_updated": "2012-05-24",
        "status": "A",
        "authorized_official_last_name": "STAKEM",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-529-8889",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S., M.D."
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Oral & Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• First Coast Mobility LLC
• First Coast Pain and Spine Center LLC
• First Coast Pain Consultants PLLC
• First Coast Pain Management
• First Coast Physical Therapy Inc
• First Coast Pulmonary Associates

• Oral & Maxillofacial Surgery (D.M.D.) in St Augustine, FL
• Providers in St Augustine, FL by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2012; 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.