NPIMap

Organization Active NPI

Southside Oral & Facial Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Chester, VA
National Provider Identifier
1801067285
Registry record updated Mar 13, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
4685 Issued in VA
Legal business name
SOUTHSIDE ORAL & FACIAL SURGERY
Practice address
11971 Iron Bridge Rd
Chester, VA 23831-1458
Phone
(804) 717-5275
Fax
(804) 748-4017
NPI assigned
Mar 13, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2008

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

Authorized official

Name
Dr. Bradley Scott Trotter, D.D.S.NPI 1932137825
Title
Dentist
Phone
(804) 717-5275

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 4685 VA Primary

Addresses

Primary practice location

11971 Iron Bridge Rd
Chester, VA 23831-1458

Mailing address

11971 Iron Bridge Rd
Chester, VA 23831-1458
Phone (804) 717-5275

Other identifiers 12

IdentifierTypeStateIssuer
9185610MedicaidVA
219899OtherANTHEM BC&BS
219900OtherANTHEM BC&BS
386682OtherANTHEM BC&BS
386686OtherANTHEM BC&BS
259641OtherANTHEM BC&BS
9179952MedicaidVA
9202377MedicaidVA
005298OtherANTHEM BC&BS
005299OtherANTHEM BC&BS
386684OtherANTHEM BC&BS
9185611MedicaidVA

Other names 1

  • Drs. O'Neill, Trotter & Brinser Former legal business name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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": "1205366400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205366400000",
    "number": "1801067285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11971 IRON BRIDGE RD",
            "city": "CHESTER",
            "state": "VA",
            "postal_code": "238311458",
            "telephone_number": "804-717-5275",
            "fax_number": "804-748-4017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11971 IRON BRIDGE RD",
            "city": "CHESTER",
            "state": "VA",
            "postal_code": "238311458",
            "telephone_number": "804-717-5275",
            "fax_number": "804-748-4017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHSIDE ORAL & FACIAL SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-13",
        "last_updated": "2008-03-13",
        "status": "A",
        "authorized_official_last_name": "TROTTER",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "804-717-5275",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "VA",
            "license": "4685",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9185610",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BC&BS",
            "identifier": "219899",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BC&BS",
            "identifier": "219900",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BC&BS",
            "identifier": "386682",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BC&BS",
            "identifier": "386686",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BC&BS",
            "identifier": "259641",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9179952",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9202377",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BC&BS",
            "identifier": "005298",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BC&BS",
            "identifier": "005299",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BC&BS",
            "identifier": "386684",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9185611",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Drs. O'Neill, Trotter & Brinser",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Chester, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 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.