Southern de Oral and Maxillofacial Surgery Associates, PA

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

2000106563 Issued in DE

Legal business name

SOUTHERN DE ORAL AND MAXILLOFACIAL SURGERY ASSOCIATES, PA

Doing business as

Bruce D Fisher MD DMD
Bruce D Fisher, MD, DMD

Practice address

17605 Nassau Commons Blvd Ste C
Lewes, DE 19958-6284

Phone

(302) 644-2977

Fax

(302) 645-7561

NPI assigned

Nov 24, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Bruce D Fisher, MD, DMDNPI 1679610695

Title

Owner

Phone

(302) 644-2977

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 2

• Bruce D Fisher MD DMD Doing business as
• Bruce D Fisher, MD, DMD Doing business as

Locations

Practitioners 2

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

• Bruce Donald Fisher, M.D., D.M.D.

  • Oral and Maxillofacial Surgery (Dentist)
  • Lewes, DE
  • NPI 1679610695
  NPD Authorized official
• Douglas Lynn Ditty, M.D., D.M.D.

  • Oral and Maxillofacial Surgery (Dentist)
  • Dover, DE
  • NPI 1033257530
  NPD (past)

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

{
    "created_epoch": "1164326400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654214400000",
    "number": "1629144589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17605 NASSAU COMMONS BLVD STE C",
            "city": "LEWES",
            "state": "DE",
            "postal_code": "199586284",
            "telephone_number": "302-644-2977",
            "fax_number": "302-645-7561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17605 NASSAU COMMONS BLVD STE C",
            "city": "LEWES",
            "state": "DE",
            "postal_code": "199586284",
            "telephone_number": "302-644-2977",
            "fax_number": "302-645-7561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN DE ORAL AND MAXILLOFACIAL SURGERY ASSOCIATES, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-24",
        "last_updated": "2022-06-03",
        "certification_date": "2022-06-03",
        "status": "A",
        "authorized_official_last_name": "FISHER",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "302-644-2977",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD, DMD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "DE",
            "license": "2000106563",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1000015026",
            "state": "DE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bruce D Fisher MD DMD",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bruce D Fisher, MD, DMD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ernest Soffronoff, M.D.
• Sharat Sonati, MD
• David Sopa, D.O.
• Mark A Sordi, MD
• Zarina Joy Simeon Soriano
• Southern Delaware Imaging Assoc
• Southern Delaware Physical Therapy, Inc.
• Southern Delaware Sportscare and Rehabilitation, LLC
• Southern Delaware Vascular Institute, LLC
• Danielle Spagnolo, DPT

• Oral and Maxillofacial Surgery (Dentist) in Lewes, DE
• Providers in Lewes, DE by specialty
• Oral and Maxillofacial Surgery (Dentist) in Delaware

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 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.