Johnson City Oral and Maxillofacial Surgery, LLC

Primary specialty

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

Legal business name

JOHNSON CITY ORAL AND MAXILLOFACIAL SURGERY, LLC

Practice address

1021 W Oakland Ave Ste 109
Johnson City, TN 37604-2192

Phone

(423) 283-4555

NPI assigned

May 19, 2020

Organization subpart

No

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

Authorized official

Name

Matthew Sherban, DMDNPI 1043574114

Title

President

Phone

(423) 283-4555

Specialties & licenses 1

Addresses

Locations

Practitioners 2

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

• Matthew Sherban, D.M.D.

  • Oral and Maxillofacial Surgery (Dentist)
  • Johnson City, TN
  • NPI 1043574114
  NPD Authorized official
• Charles Edward Witkowski Sr., DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Johnson City, TN
  • NPI 1588634471
  NPD (past)

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

{
    "created_epoch": "1589846400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589846400000",
    "number": "1720601230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1021 W OAKLAND AVE STE 109",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376042192",
            "telephone_number": "423-283-4555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1021 W OAKLAND AVE STE 109",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376042192",
            "telephone_number": "423-283-4555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHNSON CITY ORAL AND MAXILLOFACIAL SURGERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-19",
        "last_updated": "2020-05-19",
        "certification_date": "2020-05-19",
        "status": "A",
        "authorized_official_last_name": "SHERBAN",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "423-283-4555",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Oral & Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Johnson City OB/GYN Associates
• Johnson City Physical Occupational Speech Outpatient Therapy, PLLC
• Johnson City Smiles, LLC
• Johnson City Speech and Language Therapy
• Johnson City Urological Clinic, P.C.
• Johnson Hearing Technology and Communication, PLLC

• Oral & Maxillofacial Surgery (D.M.D.) in Johnson City, TN
• Providers in Johnson City, TN by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 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.