Oral Surgery of West Cobb, Inc.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DN013572 Issued in GA

Legal business name

ORAL SURGERY OF WEST COBB, INC.

Practice address

5255 Stilesboro Rd NW
Ste 120
Kennesaw, GA 30152-7737

Phone

(770) 499-2152

Fax

(770) 499-2157

NPI assigned

Mar 6, 2012

Last updated

Mar 6, 2012By 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

Kellie Guffin

Title

Adminsitrator

Phone

(770) 499-2152

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1330992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330992000000",
    "number": "1801160031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5255 STILESBORO RD NW",
            "address_2": "STE 120",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301527737",
            "telephone_number": "770-499-2152",
            "fax_number": "770-499-2157"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5255 STILESBORO RD NW",
            "address_2": "STE 120",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301527737",
            "telephone_number": "770-499-2152",
            "fax_number": "770-499-2157"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORAL SURGERY OF WEST COBB, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-06",
        "last_updated": "2012-03-06",
        "status": "A",
        "authorized_official_last_name": "GUFFIN",
        "authorized_official_first_name": "KELLIE",
        "authorized_official_title_or_position": "ADMINSITRATOR",
        "authorized_official_telephone_number": "770-499-2152"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "GA",
            "license": "DN013572",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 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.