Plateau Oral Surgery, PC

Primary specialty

Oral and Maxillofacial Surgery Clinic/CenterTaxonomy code 261QS0112X

License

D57545 Issued in TN

Legal business name

PLATEAU ORAL SURGERY, PC

Practice address

920 S Willow Ave
Cookeville, TN 38501-4150

Phone

(931) 525-6059

Fax

(931) 525-6079

NPI assigned

May 4, 2010

Organization subpart

No

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

Authorized official

Name

Mrs. Nancy J Kelly

Title

Insurance Coordinator

Phone

(931) 525-6059

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1272931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529452800000",
    "number": "1730407560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 SOUTH WILLOW AVENUE",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385014150",
            "telephone_number": "931-525-6059",
            "fax_number": "931-525-6079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 S WILLOW AVE",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385014150",
            "telephone_number": "931-525-6059",
            "fax_number": "931-525-6079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PLATEAU ORAL SURGERY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-04",
        "last_updated": "2018-06-20",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "NANCY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "INSURANCE COORDINATOR",
        "authorized_official_telephone_number": "931-525-6059",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QS0112X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oral and Maxillofacial Surgery",
            "state": "TN",
            "license": "D57545",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3226373",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shanti Pittampalli, MD
• Joann Maria Pitti, COTA
• Lucas Tyler Pittman, PHYSICIAN ASSISTANT
• Plateau Behavioral Services
• Plateau Oral and Facial Surgery
• Carlos Alberto Podesta, M.D.
• Rachel Poer
• Nishan Babu Pokhrel, M.D.
• Wendy Ruth Polsky, M.S., CCC-SLP
• Salma Ponce-Hernandez, LPN

• Oral and Maxillofacial Surgery Clinic/Center in Cookeville, TN
• Providers in Cookeville, TN by specialty
• Oral and Maxillofacial Surgery Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2018; 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.