NPIMap

Organization Active NPI

Upstate Oral and Maxillofacial Surgery, P.a.

  • Oral and Maxillofacial Surgery (Dentist)
  • Spartanburg, SC
National Provider Identifier
1366577389
Registry record updated Jan 6, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
2121 Issued in SC
Legal business name
UPSTATE ORAL AND MAXILLOFACIAL SURGERY, P.A.
Practice address
280 North Grove Medical Park Dr.
Spartanburg, SC 29303-4222
Phone
(864) 585-3318
Fax
(864) 585-4800
NPI assigned
Feb 22, 2007
Organization subpart
Yes
Parent organization
UPSTATE ORAL AND MAXILLOFACIAL SURGERY, P.A.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 6, 2011

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

Authorized official

Name
Dr. Wiiliam P. Mills Jr., DMD
Title
Owner
Phone
(864) 585-3318

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223S0112X 2121 SC Primary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223S0112X 2143 SC

Addresses

Primary practice location

280 North Grove Medical Park Dr.
Spartanburg, SC 29303-4222

Mailing address

280 North Grove Medical Park Drive
Spartanburg, SC 29303-4222
Phone (864) 585-3318

Other identifiers 3

IdentifierTypeStateIssuer
ZA9899MedicaidSC
Z21218MedicaidSC
Z21432MedicaidSC

National Provider Directory

National Provider Directory
Part of
Upstate Oral Maxillo

Locations

280 North Grove Medical Park Dr
Spartanburg, SC 29303
Phone (864) 585-3318

Practitioners & affiliated clinicians

Practitioners 5

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": "1172102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294272000000",
    "number": "1366577389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "280 NORTH GROVE MEDICAL PARK DRIVE",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293034222",
            "telephone_number": "864-585-3318",
            "fax_number": "864-585-4800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "280 NORTH GROVE MEDICAL PARK DR.",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293034222",
            "telephone_number": "864-585-3318",
            "fax_number": "864-585-4800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UPSTATE ORAL AND MAXILLOFACIAL SURGERY, P.A.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "UPSTATE ORAL AND MAXILLOFACIAL SURGERY, P.A.",
        "enumeration_date": "2007-02-22",
        "last_updated": "2011-01-06",
        "status": "A",
        "authorized_official_last_name": "MILLS",
        "authorized_official_first_name": "WIILIAM",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "864-585-3318",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "SC",
            "license": "2121",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "SC",
            "license": "2143",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZA9899",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Z21218",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Z21432",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Spartanburg, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2011; 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.