Plateau Oral and Facial Surgery

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

9568 Issued in TN

Legal business name

PLATEAU ORAL AND FACIAL SURGERY

Practice address

920 S Willow Ave
Cookeville, TN 38501-4150

Phone

(931) 525-6059

Fax

(931) 525-6099

NPI assigned

Aug 4, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Cortland Caldemeyer, DDS

Title

Owner

Phone

(931) 525-6059

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1438646400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438646400000",
    "number": "1396121000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 S WILLOW AVE",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385014150",
            "telephone_number": "931-525-6059",
            "fax_number": "931-525-6099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 S WILLOW AVE",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385014150",
            "telephone_number": "931-525-6059",
            "fax_number": "931-525-6099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PLATEAU ORAL AND FACIAL SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-04",
        "last_updated": "2015-08-04",
        "status": "A",
        "authorized_official_last_name": "CALDEMEYER",
        "authorized_official_first_name": "CORTLAND",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "931-525-6059",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TN",
            "license": "9568",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q004187",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nicole Pisapia, D.O
• Shanti Pittampalli, MD
• Joann Maria Pitti, COTA
• Lucas Tyler Pittman, PHYSICIAN ASSISTANT
• Plateau Behavioral Services
• Plateau Oral Surgery, PC
• Carlos Alberto Podesta, M.D.
• Rachel Poer
• Nishan Babu Pokhrel, M.D.
• Wendy Ruth Polsky, M.S., CCC-SLP

• Oral and Maxillofacial Surgery (Dentist) in Cookeville, TN
• Providers in Cookeville, TN by specialty
• Oral and Maxillofacial Surgery (Dentist) in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2015; 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.