Midlands Oral and Maxillofacial Surgery

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

1788 Issued in SC

Legal business name

MIDLANDS ORAL AND MAXILLOFACIAL SURGERY

Practice address

1755 Saint Julian PL
Columbia, SC 29204-2409

Phone

(803) 254-2972

Fax

(803) 799-2151

NPI assigned

May 23, 2006

Organization subpart

No

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

Authorized official

Name

Diane M Montes

Title

Insurance Coordinator

Phone

(803) 254-2972

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Locations

Practitioners 6

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

• James Lemon, D.M.D

  • Oral and Maxillofacial Surgery (Dentist)
  • Columbia, SC
  • NPI 1518944404
  Medicare reassignment Care Compare group NPD
• Joseph Won-Joon Park, D.M.D

  • Oral and Maxillofacial Surgery (Dentist)
  • Columbia, SC
  • NPI 1205813227
  Medicare reassignment Care Compare group NPD
• Philip M Prickett, DMD

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Columbia, SC
  • NPI 1588629638
  Medicare reassignment Care Compare group NPD
• David Brian Tevepaugh, D.M.D

  • Oral and Maxillofacial Surgery (Dentist)
  • Columbia, SC
  • NPI 1871570804
  Medicare reassignment Care Compare group NPD
• Heath McAlvin Stewart, D.M.D

  • Oral and Maxillofacial Surgery (Dentist)
  • Columbia, SC
  • NPI 1164409058
  Medicare reassignment NPD
• Michael K Parsons, D.D.S.

  • Oral and Maxillofacial Pathology Dentistry
  • Chesterfield, MO
  • NPI 1578507109
  NPD (past)

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1386699288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1755 SAINT JULIAN PL",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292042409",
            "telephone_number": "803-254-2972",
            "fax_number": "803-799-2151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1755 SAINT JULIAN PL",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292042409",
            "telephone_number": "803-254-2972",
            "fax_number": "803-799-2151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDLANDS ORAL AND MAXILLOFACIAL SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MONTES",
        "authorized_official_first_name": "DIANE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "INSURANCE COORDINATOR",
        "authorized_official_telephone_number": "803-254-2972"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "SC",
            "license": "1788",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZA9935",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Midlands Medical Group LLC
• Midlands Medical Wellness Center, LLC
• Midlands Nephrology Associates, PA
• Midlands Neurology & Pain Assoc, P.a
• Midlands Neurology & Pain Assoc, P.a
• Midlands Orthodontics LLC
• Midlands Orthopaedics and Neurosurgery PA
• Midlands Orthopaedics and Neurosurgery PA
• Midlands Orthopaedics and Neurosurgery, PA
• Midlands Orthopaedics and Neurosurgery, PA

• Oral and Maxillofacial Surgery (Dentist) in Columbia, SC
• Providers in Columbia, SC by specialty
• Oral and Maxillofacial Surgery (Dentist) in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.