Eastgate Oral Surgery and Implants

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

EASTGATE ORAL SURGERY AND IMPLANTS

Practice address

4452 Eastgate Blvd Ste 107
Cincinnati, OH 45245-1584

Phone

(513) 643-3192

NPI assigned

Feb 18, 2025

Organization subpart

No

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

Authorized official

Name

Wallace S McLaurin, DMDNPI 1467846824

Title

Owner/Operator

Phone

(601) 259-6739

Specialties & licenses 1

Addresses

Practitioners 1

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

• Wallace Sigmon McLaurin

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Cincinnati, OH
  • NPI 1467846824
  NPD Authorized official

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

{
    "created_epoch": "1739836800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739836800000",
    "number": "1689479248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4452 EASTGATE BLVD STE 107",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452451584",
            "telephone_number": "513-643-3192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4452 EASTGATE BLVD STE 107",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452451584",
            "telephone_number": "513-643-3192"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTGATE ORAL SURGERY AND IMPLANTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-02-18",
        "last_updated": "2025-02-18",
        "certification_date": "2025-02-18",
        "status": "A",
        "authorized_official_last_name": "MCLAURIN",
        "authorized_official_first_name": "WALLACE",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER/OPERATOR",
        "authorized_official_telephone_number": "601-259-6739",
        "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": [],
    "endpoints": [],
    "other_names": []
}

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• Eastgate Cancer Center LLC
• Eastgate Family Vision, LLC
• Eastgate Health Care Center, LLC
• Eastgate Physical Therapy Limited Partnership
• Eastgate Radiation Oncology LLC
• Eastgate Surgery Center LLC
• Anna Eastman
• Kylie Nicole Eastman

• Oral and Maxillofacial Surgery (Dentist) in Cincinnati, OH
• Providers in Cincinnati, OH by specialty
• Oral and Maxillofacial Surgery (Dentist) in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2025; 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.