St Augustine Oral & Facial Surgical Center PA

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

DN15568 Issued in FL

Legal business name

ST AUGUSTINE ORAL & FACIAL SURGICAL CENTER PA

Practice address

1301 Plantation Island Dr S
Suite 101
St Augustine, FL 32080-3108

Phone

(904) 460-0505

Fax

(904) 460-0506

NPI assigned

May 23, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Douglas L Johnson, DDSNPI 1730292517

Title

Owner

Phone

(904) 460-0505

Specialties & licenses 3

Addresses

Other identifiers 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

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

• Douglas L Johnson, DMD

  • Oral & Maxillofacial Surgery (D.M.D.)
  • St Augustine, FL
  • NPI 1730292517

  Oral and Maxillofacial Surgery

  NPD (past) Authorized official

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

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214179200000",
    "number": "1629288824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7870",
            "city": "SPRINGDALE",
            "state": "AR",
            "postal_code": "727667870",
            "telephone_number": "479-464-5824",
            "fax_number": "479-725-2395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 PLANTATION ISLAND DR S",
            "address_2": "SUITE 101",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320803108",
            "telephone_number": "904-460-0505",
            "fax_number": "904-460-0506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST AUGUSTINE ORAL & FACIAL SURGICAL CENTER PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-23",
        "last_updated": "2008-06-23",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-460-0505",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "FL",
            "license": "DN15568",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "FL",
            "license": "DN15568",
            "primary": true
        },
        {
            "code": "2082S0099X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Plastic Surgery, Plastic Surgery Within the Head and Neck",
            "state": "FL",
            "license": "DN15568",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE GROUP",
            "identifier": "DD5857",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• St Augustine Endoscopy Center LLC
• St Augustine FL Opco LLC (The Lilac at Bayview)
• St Augustine FL Opco LLC (The Lilac at Bayview)
• St Augustine Medical Equipment LLC
• St Augustine Neurology PA
• St Augustine Physical Medicine
• St Augustine Physicians Associates Inc (Monahan Chiropractic)
• St Augustine Physicians Associates Inc. (Monahan Chiropractic)
• St Augustine Primary Care P L
• St Augustine Senior Living LLC (Tranquil Oaks Assisted Living)

• Oral & Maxillofacial Surgery (D.M.D.) in St Augustine, FL
• Providers in St Augustine, FL by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.