NPIMap

Organization Active NPI

Suburban Oral Surgery LLC

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Drexel Hill, PA
National Provider Identifier
1487247607
Registry record updated Feb 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X
Legal business name
SUBURBAN ORAL SURGERY LLC
Practice address
2300 Garrett Road
Drexel Hill, PA 19026-1102
Phone
(610) 623-4211
Fax
(610) 623-2850
NPI assigned
Feb 18, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2021

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

Authorized official

Name
Dr. Richard James Clark III, DDSNPI 1942249545
Title
President
Phone
(610) 513-9137

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral & Maxillofacial Surgery (D.M.D.)Group: 193400000X SINGLE SPECIALTY GROUP 204E00000X Primary

Addresses

Primary practice location

2300 Garrett Road
Drexel Hill, PA 19026-1102

Mailing address

2300 Garrett Road
Drexel Hill, PA 19026-1102
Phone (610) 623-4211

National Provider Directory

National Provider Directory

Locations

2300 Garrett Rd
Drexel Hill, PA 19026
Phone (610) 623-4211

Practitioners & affiliated clinicians

Practitioners 3

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": "1613606400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613606400000",
    "number": "1487247607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 GARRETT ROAD",
            "city": "DREXEL HILL",
            "state": "PA",
            "postal_code": "190261102",
            "telephone_number": "610-623-4211",
            "fax_number": "610-623-2850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 GARRETT ROAD",
            "city": "DREXEL HILL",
            "state": "PA",
            "postal_code": "190261102",
            "telephone_number": "610-623-4211",
            "fax_number": "610-623-2850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUBURBAN ORAL SURGERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-18",
        "last_updated": "2021-02-18",
        "certification_date": "2021-02-18",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "610-513-9137",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Oral & Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Drexel Hill, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2021; 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.