River Valley Oral & Maxillofacial Surgery PLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

2226 Issued in AR

Legal business name

RIVER VALLEY ORAL & MAXILLOFACIAL SURGERY PLC

Practice address

2407 S Waldron Rd
Fort Smith, AR 72903-3736

Phone

(479) 484-1011

Fax

(479) 484-1205

NPI assigned

Jul 18, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Gayle M. Freeman

Title

Office Manager

Phone

(479) 484-1011

Specialties & licenses 1

Addresses

Other identifiers 11

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• John Brandebura Jr., D.M.D.

  • Oral and Maxillofacial Surgery (Dentist)
  • Fort Smith, AR
  • NPI 1629038708
  NPD (past)

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1240790400000",
    "number": "1548288244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2407 S WALDRON RD",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729033736",
            "telephone_number": "479-484-1011",
            "fax_number": "479-484-1205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2407 S WALDRON RD",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729033736",
            "telephone_number": "479-484-1011",
            "fax_number": "479-484-1205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVER VALLEY ORAL & MAXILLOFACIAL SURGERY PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-18",
        "last_updated": "2009-04-27",
        "status": "A",
        "authorized_official_last_name": "FREEMAN",
        "authorized_official_first_name": "GAYLE",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "479-484-1011",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "AR",
            "license": "2226",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA (IND-JR)",
            "identifier": "000516007",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "127322679",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "58111",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100026580A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA (GRP)",
            "identifier": "000861460",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100174630A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1871553958",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "58041",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA (IND-JB)",
            "identifier": "000812852",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "127321679",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1629038708",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• River Valley Back and Neck Clinic, Inc
• River Valley Community Center
• River Valley Dental Group PLLC
• River Valley Gastroenterology, PLLC
• River Valley Mobile Dental Clinic
• River Valley Pediatric Dentistry PLLC
• River Valley Pediatrics LLC
• River Valley Primary Care
• River Valley Primary Care Services
• River Valley Primary Care Services

• Oral and Maxillofacial Surgery (Dentist) in Fort Smith, AR
• Providers in Fort Smith, AR by specialty
• Oral and Maxillofacial Surgery (Dentist) in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2009; 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.