Snellville Oral Surgery LLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

07968 Issued in GA

Legal business name

SNELLVILLE ORAL SURGERY LLC

Practice address

2221 Knollwood Drive
Snellville, GA 30078

Phone

(770) 972-7911

Fax

(770) 978-3767

NPI assigned

Dec 13, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Dale Ellis, DMD

Title

Owner

Phone

(770) 972-7911

Specialties & licenses 2

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Sammy Dale Ellis, DMD

  • Oral and Maxillofacial Surgery (Dentist)
  • Snellville, GA
  • NPI 1639112345
  NPD (past)
• James Eugene Haddad Jr., DMD

  • Oral and Maxillofacial Surgery (Dentist)
  • Snellville, GA
  • NPI 1720021439
  NPD (past)

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

{
    "created_epoch": "1197504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1361404800000",
    "number": "1487837423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2221 KNOLLWOOD DRIVE",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "30078",
            "telephone_number": "770-972-7911",
            "fax_number": "770-978-3767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2221 KNOLLWOOD DRIVE",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "30078",
            "telephone_number": "770-972-7911",
            "fax_number": "770-978-3767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SNELLVILLE ORAL SURGERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-13",
        "last_updated": "2013-02-21",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "DALE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-972-7911",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "GA",
            "license": "07968",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "GA",
            "license": "DN012320",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• SN Gwinett County Radiation
• Snellivlle Medical Imaging
• Snellville Dental Smiles
• Snellville DME, LLC
• Snellville Medical Group, P.C.
• Snellville Pediatrics, P.C.
• Snellville Primary Care
• SNH Georgia Tenant LLC (Eastside Gardens)
• Bethany A Snyder, ATC
• Temitope Sobo

• Oral and Maxillofacial Surgery (Dentist) in Snellville, GA
• Providers in Snellville, GA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2013; 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.