Huntsville Oral and Maxillofacial Surgery Associates, PC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

5313 Issued in AL

Legal business name

HUNTSVILLE ORAL AND MAXILLOFACIAL SURGERY ASSOCIATES, PC

Practice address

2314 Pansy St SW
Huntsville, AL 35801-3803

Phone

(256) 534-5028

Fax

(256) 534-5073

NPI assigned

Sep 16, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Philip Brent Elledge, DMD

Title

Owner

Phone

(256) 534-5028

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1158364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187136000000",
    "number": "1386740140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2314 PANSY ST SW",
            "city": "HUNTSVILLE",
            "state": "AL",
            "postal_code": "358013803",
            "telephone_number": "256-534-5028",
            "fax_number": "256-534-5073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2314 PANSY ST SW",
            "city": "HUNTSVILLE",
            "state": "AL",
            "postal_code": "358013803",
            "telephone_number": "256-534-5028",
            "fax_number": "256-534-5073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HUNTSVILLE ORAL AND MAXILLOFACIAL SURGERY ASSOCIATES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-16",
        "last_updated": "2007-08-15",
        "status": "A",
        "authorized_official_last_name": "ELLEDGE",
        "authorized_official_first_name": "PHILIP",
        "authorized_official_middle_name": "BRENT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "256-534-5028",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "AL",
            "license": "5313",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Oral and Maxillofacial Surgery (Dentist) in Huntsville, AL
• Providers in Huntsville, 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 Aug 15, 2007; 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.