Fayetteville-Manlius Oral Surgery, P.C

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

FAYETTEVILLE-MANLIUS ORAL SURGERY, P.C

Practice address

8240 Cazenovia Rd Ste 60
Manlius, NY 13104-8814

Phone

(315) 692-0449

Fax

(315) 692-6546

NPI assigned

Jun 16, 2021

Organization subpart

No

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

Authorized official

Name

Dr. Edious Kwaipa Elliot, DMDNPI 1639434665

Title

President

Phone

(315) 692-0449

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

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

• Edious K. Elliot, DMD

  • Oral and Maxillofacial Surgery (Dentist)
  • Manlius, NY
  • NPI 1639434665

  Oral and Maxillofacial Surgery

  NPD Authorized official

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

{
    "created_epoch": "1623801600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623801600000",
    "number": "1649848458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8240 CAZENOVIA RD STE 60",
            "city": "MANLIUS",
            "state": "NY",
            "postal_code": "131048814",
            "telephone_number": "315-692-0449",
            "fax_number": "315-692-6546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8240 CAZENOVIA RD STE 60",
            "city": "MANLIUS",
            "state": "NY",
            "postal_code": "131048814",
            "telephone_number": "315-692-0449",
            "fax_number": "315-692-6546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAYETTEVILLE-MANLIUS ORAL SURGERY, P.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-16",
        "last_updated": "2021-06-16",
        "certification_date": "2021-06-16",
        "status": "A",
        "authorized_official_last_name": "ELLIOT",
        "authorized_official_first_name": "EDIOUS",
        "authorized_official_middle_name": "KWAIPA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "315-692-0449",
        "authorized_official_name_prefix": "Dr.",
        "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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "163-943-4665",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Charlotte Giovanna Ennis, DPT
• Mark Steven Erlebacher, M.D.
• Fairgrounds Family Physicians PLLC
• Fairway Management, LLC
• Fayetteville Manlius School District
• Adam Feck
• Karen Fernandez-Cosgrove, PH.D., LMFT
• Jessica M Fetterman, PA
• Lia Fischi
• Sophie Katherine Fowler

• All providers in Manlius, NY
• Oral and Maxillofacial Surgery (Dentist) in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2021; 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.