NPIMap

Organization Active NPI

Fresno Oral Maxillofacial Surgery and Dental Implant Center

  • Oral and Maxillofacial Surgery (Dentist)
  • Fresno, CA
National Provider Identifier
1750481735
Registry record updated May 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
Legal business name
FRESNO ORAL MAXILLOFACIAL SURGERY AND DENTAL IMPLANT CENTER
Practice address
1903 E Fir Ave Ste 101
Fresno, CA 93720-3862
Phone
(559) 226-2722
Fax
(559) 226-6989
NPI assigned
Sep 22, 2006
Last updated
May 14, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 14, 2021

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

Authorized official

Name
Mr. Ryan Smith
Title
Director of Operations
Phone
(559) 326-5932

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X NU Primary

Addresses

Primary practice location

1903 E Fir Ave Ste 101
Fresno, CA 93720-3862

Mailing address

1903 E Fir Ave Ste 101
Fresno, CA 93720-3862
Phone (559) 226-2722

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080310000375 CA Part B Supplier - Clinic/Group Practice 4981789377 Receives reassigned benefits from 6 practitioners
Practice locations: Madera, CA; Visalia, CA; Fresno, CA; Clovis, CA

National Provider Directory

National Provider Directory

Locations

2026 Shaw Ave
Ste 101
Clovis, CA 93611
Phone (559) 472-4050

7025 N Maple Ave
Ste 108
Fresno, CA 93720
Phone (559) 226-2722

242 W Caldwell Ave
Visalia, CA 93277
Phone (559) 226-2722

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620950400000",
    "number": "1750481735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1903 E FIR AVE STE 101",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937203862",
            "telephone_number": "559-226-2722",
            "fax_number": "559-226-6989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1903 E FIR AVE STE 101",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937203862",
            "telephone_number": "559-226-2722",
            "fax_number": "559-226-6989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRESNO ORAL MAXILLOFACIAL SURGERY AND DENTAL IMPLANT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-22",
        "last_updated": "2021-05-14",
        "certification_date": "2021-05-14",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "559-326-5932",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fresno, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.