St Lawerence Oral and Maxilliofacial Surgery

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

0345831 Issued in NY

Legal business name

ST LAWERENCE ORAL AND MAXILLIOFACIAL SURGERY

Practice address

6604 State Highway 56
Potsdam, NY 13676

Phone

(315) 265-1761

Fax

(315) 265-1768

NPI assigned

Sep 29, 2006

Organization subpart

No

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

Authorized official

Name

Erhart A Beuttenmuller, DDS

Title

Secretary

Phone

(315) 265-1761

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1159488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1710079371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6604 STATE HIGHWAY 56",
            "city": "POTSDAM",
            "state": "NY",
            "postal_code": "13676",
            "telephone_number": "315-265-1761",
            "fax_number": "315-265-1768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6604 STATE HIGHWAY 56",
            "city": "POTSDAM",
            "state": "NY",
            "postal_code": "13676",
            "telephone_number": "315-265-1761",
            "fax_number": "315-265-1768"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST LAWERENCE ORAL AND MAXILLIOFACIAL SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BEUTTENMULLER",
        "authorized_official_first_name": "ERHART",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "315-265-1761",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NY",
            "license": "0345831",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01456399",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Erin Southwick
• Cherish Spencer, MSN, CNM
• Jennie Spooner
• Kim L. Sprague, RPH
• Mallory Sprague, MD
• St Lawrence Radiology Assoc PC
• St. Lawrence Cardiology
• St. Lawrence Oral and Maxillofacial Surgery Associates PC
• St. Lawrence Orthopedics Specialists PC
• Amy St.Hilaire, RN

• Oral and Maxillofacial Surgery (Dentist) in Potsdam, NY
• Providers in Potsdam, NY by specialty
• 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 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.