Organization Active NPI

Oral and Maxillofacial Surgery, LTD.

  • Oral and Maxillofacial Surgery (Dentist)
  • Greensburg, PA
National Provider Identifier
1629020771
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
Legal business name
ORAL AND MAXILLOFACIAL SURGERY, LTD.
Practice address
31 N Maple Ave
Greensburg, PA 15601-2503
Phone
(724) 837-7770
Fax
(724) 838-7731
NPI assigned
May 17, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Robert W Queale, DMDNPI 1801877006
Title
President
Phone
(724) 837-7770

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 Primary

Addresses

Primary practice location

31 N Maple Ave
Greensburg, PA 15601-2503

Mailing address

31 N Maple Ave
Greensburg, PA 15601-2503
Phone (724) 837-7770

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050204000430 PA Part B Supplier - Clinic/Group Practice 7012968217 Receives reassigned benefits from 3 practitioners
Practice locations: Greensburg, PA; Murrysville, PA

National Provider Directory

National Provider Directory

Locations

31 N Maple Ave
Greensburg, PA 15601
Phone (724) 837-7770

Practitioners & affiliated clinicians

Practitioners 4

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": "1147824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1629020771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 N MAPLE AVE",
            "city": "GREENSBURG",
            "state": "PA",
            "postal_code": "156012503",
            "telephone_number": "724-837-7770",
            "fax_number": "724-838-7731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 N MAPLE AVE",
            "city": "GREENSBURG",
            "state": "PA",
            "postal_code": "156012503",
            "telephone_number": "724-837-7770",
            "fax_number": "724-838-7731"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORAL AND MAXILLOFACIAL SURGERY, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "QUEALE",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "724-837-7770",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greensburg, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.