NPIMap

Organization Active NPI

Southeastern-Oms, LLC

Doing business as Southeastern Oral - Maxillofacial & Facial Cosmetic Surgery Center

  • Oral and Maxillofacial Surgery (Dentist)
  • Dothan, AL
National Provider Identifier
1609615871
Registry record updated May 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
Legal business name
SOUTHEASTERN-OMS, LLC
Doing business as
Southeastern Oral - Maxillofacial & Facial Cosmetic Surgery Center
Practice address
216 Healthwest Dr
Dothan, AL 36303-1942
Phone
(334) 792-2880
Fax
(334) 712-0202
NPI assigned
May 20, 2024
Last updated
May 20, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2024

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

Authorized official

Name
Dr. Gregory C Bess, DMD, MDNPI 1316921745
Title
Oral Surgeon/Owner
Phone
(334) 792-2880

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) 1223S0112X NU Primary

Addresses

Primary practice location

216 Healthwest Dr
Dothan, AL 36303-1942

Mailing address

216 Healthwest Dr
Dothan, AL 36303-1942
Phone (334) 792-2880

Other practice location 1

813 E Lee St
Enterprise, AL 36330-2072
Phone (334) 792-2880

Other names 1

  • Southeastern Oral - Maxillofacial & Facial Cosmetic Surgery Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20260202001859 AL Part B Supplier - Clinic/Group Practice 1658859566 Receives reassigned benefits from 3 practitioners
Practice locations: Dothan, AL

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

813 E Lee St
Enterprise, AL 36330
Phone (334) 308-9634

Practitioners & affiliated clinicians

Practitioners 5

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": "1716163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716163200000",
    "number": "1609615871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "216 HEALTHWEST DR",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363031942",
            "telephone_number": "334-792-2880",
            "fax_number": "334-712-0202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "216 HEALTHWEST DR",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363031942",
            "telephone_number": "334-792-2880",
            "fax_number": "334-712-0202"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "813 E Lee St",
            "address_purpose": "LOCATION",
            "city": "Enterprise",
            "state": "AL",
            "postal_code": "363302072",
            "country_code": "US",
            "telephone_number": "334-792-2880",
            "fax_number": "334-712-0202",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTHEASTERN-OMS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-20",
        "last_updated": "2024-05-20",
        "certification_date": "2024-05-20",
        "status": "A",
        "authorized_official_last_name": "BESS",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "ORAL SURGEON/OWNER",
        "authorized_official_telephone_number": "334-792-2880",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD, MD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southeastern Oral - Maxillofacial & Facial Cosmetic Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dothan, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.