Foothill Oral Surgery Center

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

41907 Issued in CA

Legal business name

FOOTHILL ORAL SURGERY CENTER

Practice address

27725 Santa Margarita Pkwy
Suite 130
Mission Viejo, CA 92691-6704

Phone

(949) 470-3672

Fax

(949) 472-2095

NPI assigned

May 10, 2007

Organization subpart

No

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

Authorized official

Name

Teri Birkenbach

Title

Office Manager

Phone

(949) 470-3672

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Michael Kenneth Clark, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Mission Viejo, CA
  • NPI 1619316403
  NPD (past)

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

{
    "created_epoch": "1178755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1629282355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27725 SANTA MARGARITA PKWY",
            "address_2": "SUITE 130",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926916704",
            "telephone_number": "949-470-3672",
            "fax_number": "949-472-2095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27725 SANTA MARGARITA PKWY",
            "address_2": "SUITE 130",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926916704",
            "telephone_number": "949-470-3672",
            "fax_number": "949-472-2095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOOTHILL ORAL SURGERY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BIRKENBACH",
        "authorized_official_first_name": "TERI",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "949-470-3672"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "41907",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Oral and Maxillofacial Surgery (Dentist) in Mission Viejo, CA
• Providers in Mission Viejo, CA by specialty
• Oral and Maxillofacial Surgery (Dentist) in California

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.