Rodrigo Lorenzo Uribe, D.M.D.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DN011060 Issued in GA

Practice address

613 E Grady St
Statesboro, GA 30458-5104

Phone

(912) 764-5435

Fax

(912) 764-9789

NPI assigned

Jul 26, 2006

Last updated

Oct 30, 2018By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Apr 1, 2018 through Apr 1, 2028

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• East Georgia Oral & Maxillofacial Surgery Center

  • Dental Clinic/Center
  • Statesboro, GA
  • NPI 1184946337
  NPD (past) Authorized official

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540857600000",
    "number": "1811911977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "613 EAST GRADY STREET",
            "address_2": "P.O.BOX 1408",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304591408",
            "telephone_number": "912-764-5435",
            "fax_number": "912-764-9789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "613 E GRADY ST",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304585104",
            "telephone_number": "912-764-5435",
            "fax_number": "912-764-9789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "URIBE",
        "first_name": "RODRIGO",
        "middle_name": "LORENZO",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-26",
        "last_updated": "2018-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "GA",
            "license": "DN011060",
            "primary": true
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "GA",
            "license": "DN011060",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000514489A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ethan Ronald Turner
• Stephanie Turner, MS, RD, LD
• Terri Tyson, LPC
• Bethrand Okafor Ugwu, PA-C
• Linda A L Upchurch, APRN, BC
• Bailey Nicole Usher
• Timothy Rollins Ussery, ATC
• Monica Delgado Vanwagenen
• Emily Vasquez
• Autumn Venturelli, PA

• Oral and Maxillofacial Surgery (Dentist) in Statesboro, GA
• Providers in Statesboro, GA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.