NPIMap

Organization Active NPI

Jefferson City Oral and Maxillofacial Surgery, LLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Jefferson City, MO
National Provider Identifier
1760599732
Registry record updated Jan 31, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
Legal business name
JEFFERSON CITY ORAL AND MAXILLOFACIAL SURGERY, LLC
Practice address
1400 Southwest Blvd
Suite C
Jefferson City, MO 65109-2490
Phone
(573) 635-7216
Fax
(573) 635-2646
NPI assigned
Aug 24, 2006
Last updated
Jan 31, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2008

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

Authorized official

Name
Mrs. Dana Kay Baker
Title
Office Manager
Phone
(573) 635-7216

Specialties & licenses 1

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

Addresses

Primary practice location

1400 Southwest Blvd
Suite C
Jefferson City, MO 65109-2490

Mailing address

1400 Southwest Blvd
Suite C
Jefferson City, MO 65109-2490
Phone (573) 635-7216

National Provider Directory

National Provider Directory

Locations

1400 Southwest Blvd
Ste C
Jefferson City, MO 65109
Phone (573) 635-7216

Practitioners & affiliated clinicians

Practitioners 2

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": "1156377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201737600000",
    "number": "1760599732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 SOUTHWEST BLVD",
            "address_2": "SUITE C",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651092490",
            "telephone_number": "573-635-7216",
            "fax_number": "573-635-2646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 SOUTHWEST BLVD",
            "address_2": "SUITE C",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651092490",
            "telephone_number": "573-635-7216",
            "fax_number": "573-635-2646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON CITY ORAL AND MAXILLOFACIAL SURGERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-24",
        "last_updated": "2008-01-31",
        "status": "A",
        "authorized_official_last_name": "BAKER",
        "authorized_official_first_name": "DANA",
        "authorized_official_middle_name": "KAY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "573-635-7216",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jefferson City, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2008; 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.