Oral and Facial Surgery Center of Tallahassee

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DN17462 Issued in FL

Legal business name

ORAL AND FACIAL SURGERY CENTER OF TALLAHASSEE

Doing business as

Oral and Facial Surgery Center of

Practice address

3375 Capital Cir NE BLDG D
Suite 2
Tallahassee, FL 32308-3778

Phone

(850) 386-4602

Fax

(850) 386-4206

NPI assigned

Aug 20, 2007

Last updated

Mar 27, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Barrett R Tolley, D.D.S.NPI 1356362149

Title

Oral Surgeon / Dentist

Phone

(850) 386-4602

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Oral and Facial Surgery Center of Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Tax ID family

Oral and Facial Surgery Center of2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Oral & Facial Surgery Center of Tallahassee, P.a.

  • Oral and Maxillofacial Surgery (Dentist)
  • Tallahassee, FL
  • NPI 1306172143
  NPD tax ID

Locations

Practitioners 8

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.

• Barrett Ross Tolley, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Tallahassee, FL
  • NPI 1356362149
  Medicare reassignment NPD Authorized official
• Kyle Cross, D.M.D.

  • General Practice Dentistry
  • Tallahassee, FL
  • NPI 1790466852
  NPD (past)
• James Aubrey Davis Jr., DMD

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Tallahassee, FL
  • NPI 1093769051
  NPD (past)
• Jahquan Ingram, FNP-C

  • Nurse Practitioner
  • Tallahassee, FL
  • NPI 1205592284
  NPD (past)
• Jason Lee, D.D.S.

  • Oral and Maxillofacial Surgery (Dentist)
  • Jacksonville, FL
  • NPI 1578622908
  NPD (past)
• Ernesto Llerena, DMD

  • Dentist
  • Tallahassee, FL
  • NPI 1801402326
  NPD (past)
• Jeffrey Maurer, FNP-C

  • Family Nurse Practitioner
  • Tallahassee, FL
  • NPI 1821805896
  NPD (past)
• Charlene Myers, APRN

  • Pediatric Nurse Practitioner
  • Tallahassee, FL
  • NPI 1386461366
  NPD (past)

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

{
    "created_epoch": "1187568000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1553644800000",
    "number": "1770776155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3330 CAPITAL OAKS DR STE 2",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323084513",
            "telephone_number": "850-386-4602",
            "fax_number": "850-386-4206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3375 CAPITAL CIR NE BLDG D",
            "address_2": "SUITE 2",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323083778",
            "telephone_number": "850-386-4602",
            "fax_number": "850-386-4206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORAL AND FACIAL SURGERY CENTER OF TALLAHASSEE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-20",
        "last_updated": "2019-03-27",
        "status": "A",
        "authorized_official_last_name": "TOLLEY",
        "authorized_official_first_name": "BARRETT",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "ORAL SURGEON / DENTIST",
        "authorized_official_telephone_number": "850-386-4602",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "FL",
            "license": "DN17462",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "87451",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "076811100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Oral and Facial Surgery Center of",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Oral and Facial Surgery Center of",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Operation Phoenix Men's Health PLLC
• Rachel Claire Oppenheim
• Optisave Inc
• Optum Infusion Services 205, Inc
• Oral & Facial Surgery Center of Tallahassee, P.a.
• Orchard ABA, LLC
• Karen Orellana Heizer, PA-C
• Heather Lynn Orender
• Reiner Orense
• Olivia Origa

• Oral and Maxillofacial Surgery (Dentist) in Tallahassee, FL
• Providers in Tallahassee, FL by specialty
• Oral and Maxillofacial Surgery (Dentist) in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2019; 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.