Eastern Shore Oral, Facial and Implant Surgery Center, P.C.

Primary specialty

Oral and Maxillofacial Surgery Clinic/CenterTaxonomy code 261QS0112X

License

6357 Issued in AL

Legal business name

EASTERN SHORE ORAL, FACIAL AND IMPLANT SURGERY CENTER, P.C.

Practice address

24172 4TH Street
Fairhope, AL 36532

Phone

(251) 333-1700

Fax

(251) 333-1701

NPI assigned

Jul 24, 2017

Organization subpart

No

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

Authorized official

Name

Richard Cordero, DMD, MD

Title

Owner/ Surgeon

Phone

(251) 333-1700

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1500854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1568985349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24172 4TH STREET",
            "city": "FAIRHOPE",
            "state": "AL",
            "postal_code": "36532",
            "telephone_number": "251-333-1700",
            "fax_number": "251-333-1701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24172 4TH STREET",
            "city": "FAIRHOPE",
            "state": "AL",
            "postal_code": "36532",
            "telephone_number": "251-333-1700",
            "fax_number": "251-333-1701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERN SHORE ORAL, FACIAL AND IMPLANT SURGERY CENTER, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-24",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "CORDERO",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "OWNER/ SURGEON",
        "authorized_official_telephone_number": "251-333-1700",
        "authorized_official_credential": "DMD, MD"
    },
    "taxonomies": [
        {
            "code": "261QS0112X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oral and Maxillofacial Surgery",
            "state": "AL",
            "license": "6357",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eastern Shore Health Center, LLC (Suzanne Tormoen, MD)
• Eastern Shore Heart Center
• Eastern Shore Internal Medicine, LLC
• Eastern Shore Medical Specialists, LLC
• Eastern Shore Mental Wellness Center
• Eastern Shore Orthopaedic Center, P.C.
• Eastern Shore Orthotics & (Hanger Clinic)
• Eastern Shore Pharmacy, LLC (Eastern Shore Pharmacy)
• Easternshore OBGYN
• Stacy Lynette Edwards, MFT-I

• Oral and Maxillofacial Surgery Clinic/Center in Fairhope, AL
• Providers in Fairhope, AL by specialty
• Oral and Maxillofacial Surgery Clinic/Center in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.