NPIMap

Organization Active NPI

Kernan Oral Maxillofacial & Implant Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Centerville, OH
National Provider Identifier
1538330089
Registry record updated Mar 12, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
18518 Issued in OH
Legal business name
KERNAN ORAL MAXILLOFACIAL & IMPLANT SURGERY
Practice address
9995 Dayton Lebanon Pike
Centerville, OH 45458
Phone
(937) 885-7204
Fax
(937) 885-7206
NPI assigned
Mar 12, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2008

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

Authorized official

Name
Mr. Brian Thomas Kernan, DDSNPI 1447343561
Title
President Oral Maxillofacial Surgeo
Phone
(937) 885-7204

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 and Maxillofacial Surgery (Dentist)Group: 193400000X SINGLE SPECIALTY GROUP 1223S0112X 18518 OH Primary

Addresses

Primary practice location

9995 Dayton Lebanon Pike
Centerville, OH 45458

Mailing address

9995 Dayton Lebanon Pike
Centerville, OH 45458
Phone (937) 885-7204

Other identifiers 3

IdentifierTypeStateIssuer
0666060MedicaidOH
KE4118162OtherOHMEDICARE INDIVIDUAL
KE9357911OtherOHMEDICARE GROUP

National Provider Directory

National Provider Directory

Locations

9995 Dayton Lebanon Pike
Dayton, OH 45458
Phone (937) 885-7204

Practitioners & affiliated clinicians

Practitioners 1

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": "1205280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205280000000",
    "number": "1538330089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9995 DAYTON LEBANON PIKE",
            "city": "CENTERVILLE",
            "state": "OH",
            "postal_code": "45458",
            "telephone_number": "937-885-7204",
            "fax_number": "937-885-7206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9995 DAYTON LEBANON PIKE",
            "city": "CENTERVILLE",
            "state": "OH",
            "postal_code": "45458",
            "telephone_number": "937-885-7204",
            "fax_number": "937-885-7206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KERNAN ORAL MAXILLOFACIAL & IMPLANT SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-12",
        "last_updated": "2008-03-12",
        "status": "A",
        "authorized_official_last_name": "KERNAN",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "PRESIDENT ORAL MAXILLOFACIAL SURGEO",
        "authorized_official_telephone_number": "937-885-7204",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "OH",
            "license": "18518",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0666060",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE INDIVIDUAL",
            "identifier": "KE4118162",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "KE9357911",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Centerville, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2008; 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.