Facial & Oral Surgery Associates, Inc.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

D3016 Issued in ID

Legal business name

FACIAL & ORAL SURGERY ASSOCIATES, INC.

Practice address

165 N 14TH Ave
Pocatello, ID 83201-4146

Phone

(208) 232-2807

Fax

(208) 232-8118

NPI assigned

Dec 5, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Wende Stuart

Title

Office Administrator

Phone

(208) 232-2807

Specialties & licenses 1

Addresses

Other identifiers 5

Locations

Practitioners 1

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

• Jeffrey S Dean, D.D.S., M.D., FACS

  • Oral and Maxillofacial Surgery (Dentist)
  • Dakota Dunes, SD
  • NPI 1073687711
  NPD (past)

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

{
    "created_epoch": "1196812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1276646400000",
    "number": "1649453275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6033",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832056033",
            "telephone_number": "208-232-2807",
            "fax_number": "208-232-8118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "165 N 14TH AVE",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014146",
            "telephone_number": "208-232-2807",
            "fax_number": "208-232-8118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FACIAL & ORAL SURGERY ASSOCIATES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-05",
        "last_updated": "2010-06-16",
        "status": "A",
        "authorized_official_last_name": "STUART",
        "authorized_official_first_name": "WENDE",
        "authorized_official_title_or_position": "OFFICE ADMINISTRATOR",
        "authorized_official_telephone_number": "208-232-2807",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "ID",
            "license": "D3016",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "190005336",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "190009031",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805112100",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805112200",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805177600",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katelin Scott Evans, LPC
• Kimberly Evans
• Lauri Evans, MSW
• Nicholas Evans, LSW
• Sunny Evans, LPC
• Robert L Fackrell, DDS
• Jennifer Katherine Fah, PT, DPT
• Connor Fairbanks, DDS
• Robin Pierce Falslev, M.A., CCC-SLP
• Family Focus Mental Health LLC

• Oral and Maxillofacial Surgery (Dentist) in Pocatello, ID
• Providers in Pocatello, ID by specialty
• Oral and Maxillofacial Surgery (Dentist) in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2010; 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.