NPIMap

Organization Active NPI

Blue Ash Oral and Maxillofacial Surgery, Inc

  • Dental Clinic/Center
  • Cincinnati, OH
National Provider Identifier
1588759609
Registry record updated Mar 4, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
30-1-8892 Issued in OH
Legal business name
BLUE ASH ORAL AND MAXILLOFACIAL SURGERY, INC
Practice address
4350 Malsbary Rd
Suite 201
Cincinnati, OH 45242-5621
Phone
(513) 984-2100
Fax
(513) 984-2155
NPI assigned
Oct 4, 2006
Last updated
Mar 4, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2008

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

Authorized official

Name
Dr. Randall David Stastny, D.M.D.NPI 1699772509
Title
Owner
Phone
(513) 984-2100

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 30-1-8892 OH Primary

Addresses

Primary practice location

4350 Malsbary Rd
Suite 201
Cincinnati, OH 45242-5621

Mailing address

4350 Malsbary Rd
Suite 201
Cincinnati, OH 45242-5621
Phone (513) 984-2100

National Provider Directory

National Provider Directory

Locations

4350 Malsbary Rd
Ste 201
Blue Ash, OH 45242
Phone (513) 984-2100

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204588800000",
    "number": "1588759609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4350 MALSBARY RD",
            "address_2": "SUITE 201",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452425621",
            "telephone_number": "513-984-2100",
            "fax_number": "513-984-2155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4350 MALSBARY RD",
            "address_2": "SUITE 201",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452425621",
            "telephone_number": "513-984-2100",
            "fax_number": "513-984-2155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE ASH ORAL AND MAXILLOFACIAL SURGERY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-04",
        "last_updated": "2008-03-04",
        "status": "A",
        "authorized_official_last_name": "STASTNY",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "513-984-2100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "OH",
            "license": "30-1-8892",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cincinnati, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 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.