NPIMap

Organization Active NPI

Wells Oral & Maxillofacial Surgery Association

  • Oral and Maxillofacial Surgery (Dentist)
  • Jacksonville, FL
National Provider Identifier
1801140678
Registry record updated Nov 1, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
8078 Issued in FL
Legal business name
WELLS ORAL & MAXILLOFACIAL SURGERY ASSOCIATION
Practice address
4225 Southpoint Pkwy S
Jacksonville, FL 32216-0975
Phone
(904) 296-2226
Fax
(904) 296-8887
NPI assigned
Nov 1, 2012
Last updated
Nov 1, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2012

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

Authorized official

Name
Dr. Marvin C Wells, D.M.DNPI 1063416055
Title
President
Phone
(904) 296-2226

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X 8078 FL Primary

Addresses

Primary practice location

4225 Southpoint Pkwy S
Jacksonville, FL 32216-0975

Mailing address

4225 Southpoint Pkwy S
Jacksonville, FL 32216-0975
Phone (904) 296-2226

Other identifiers 2

IdentifierTypeStateIssuer
0747998-00MedicaidFL
86833OtherFLBLUE CROSS & BLUE SHIELD

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1351728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351728000000",
    "number": "1801140678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4225 SOUTHPOINT PKWY S",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322160975",
            "telephone_number": "904-296-2226",
            "fax_number": "904-296-8887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4225 SOUTHPOINT PKWY S",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322160975",
            "telephone_number": "904-296-2226",
            "fax_number": "904-296-8887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLS ORAL & MAXILLOFACIAL SURGERY ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-01",
        "last_updated": "2012-11-01",
        "status": "A",
        "authorized_official_last_name": "WELLS",
        "authorized_official_first_name": "MARVIN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-296-2226",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "FL",
            "license": "8078",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0747998-00",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS & BLUE SHIELD",
            "identifier": "86833",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2012; 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.