NPIMap

Organization Active NPI

Port Royal Oral Surgery PA

  • Oral and Maxillofacial Surgery (Dentist)
  • Beaufort, SC
National Provider Identifier
1437365996
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
03964 Issued in SC
Legal business name
PORT ROYAL ORAL SURGERY PA
Practice address
14 Marshellen Dr # B
Beaufort, SC 29902-6900
Phone
(834) 729-5409
NPI assigned
May 14, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Simons Hane Jr., DMD
Title
Chairman
Phone
(843) 729-5409

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X SINGLE SPECIALTY GROUP 1223S0112X 03964 SC Primary

Addresses

Primary practice location

14 Marshellen Dr # B
Beaufort, SC 29902-6900

Mailing address

14 Marshellen Dr # B
Beaufort, SC 29902-6900
Phone (843) 729-5409

National Provider Directory

National Provider Directory

Locations

14 Marshellen Dr
#B
Beaufort, SC 29902
Phone (834) 729-5409

NPI Registry JSON

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

{
    "created_epoch": "1179100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1437365996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 MARSHELLEN DR # B",
            "city": "BEAUFORT",
            "state": "SC",
            "postal_code": "299026900",
            "telephone_number": "843-729-5409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14 MARSHELLEN DR # B",
            "city": "BEAUFORT",
            "state": "SC",
            "postal_code": "299026900",
            "telephone_number": "834-729-5409"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORT ROYAL ORAL SURGERY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HANE",
        "authorized_official_first_name": "SIMONS",
        "authorized_official_title_or_position": "CHAIRMAN",
        "authorized_official_telephone_number": "843-729-5409",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "SC",
            "license": "03964",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beaufort, SC

Sources for this page

  • 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.