NPIMap

Organization Active NPI

Upstate Oral & Maxillofacial Surgery & Dental Implant Center, P.a.

  • Oral and Maxillofacial Surgery (Dentist)
  • Easley, SC
National Provider Identifier
1770707887
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
Legal business name
UPSTATE ORAL & MAXILLOFACIAL SURGERY & DENTAL IMPLANT CENTER, P.A.
Practice address
227 S Pendleton St
Suite a
Easley, SC 29640-3047
Phone
(864) 855-0383
Fax
(864) 855-0390
NPI assigned
Apr 12, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Samer Atallah Joudeh, D.M.D.NPI 1730197641
Title
Owner
Phone
(864) 855-0383

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X SINGLE SPECIALTY GROUP 1223S0112X SC Primary

Addresses

Primary practice location

227 S Pendleton St
Suite a
Easley, SC 29640-3047

Mailing address

227 S Pendleton St
Suite a
Easley, SC 29640-3047
Phone (864) 855-0383

Other identifiers 6

IdentifierTypeStateIssuer
ZZ1503MedicaidSC
ZX3518MedicaidSC
1730197641OtherSCNPI SAMER A. JOUDEH
ZG1698MedicaidSC
1629182506OtherSCNPI W. MICHAEL RIDDLE
1780769307OtherSCNPI S. ANTHONY BOWIE

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1770707887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "227 S PENDLETON ST",
            "address_2": "SUITE A",
            "city": "EASLEY",
            "state": "SC",
            "postal_code": "296403047",
            "telephone_number": "864-855-0383",
            "fax_number": "864-855-0390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "227 S PENDLETON ST",
            "address_2": "SUITE A",
            "city": "EASLEY",
            "state": "SC",
            "postal_code": "296403047",
            "telephone_number": "864-855-0383",
            "fax_number": "864-855-0390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UPSTATE ORAL & MAXILLOFACIAL SURGERY & DENTAL IMPLANT CENTER, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JOUDEH",
        "authorized_official_first_name": "SAMER",
        "authorized_official_middle_name": "ATALLAH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "864-855-0383",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "SC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZ1503",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZX3518",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI SAMER A. JOUDEH",
            "identifier": "1730197641",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZG1698",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI W. MICHAEL RIDDLE",
            "identifier": "1629182506",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI S. ANTHONY BOWIE",
            "identifier": "1780769307",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Easley, SC

Sources for this page

  • 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.