Jacksonville Oral Surgery PLLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

JACKSONVILLE ORAL SURGERY PLLC

Practice address

2047 Park St
Jacksonville, FL 32204-3809

Phone

(904) 388-7665

NPI assigned

Jan 17, 2020

Last updated

Jul 21, 2026By 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

Victoria Johnson

Title

Cro

Phone

(941) 444-0558

Specialties & licenses 1

Addresses

Locations

Practitioners 3

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.

• Lewis Anthony Caputa, Jr., D.M.D.

  • Oral and Maxillofacial Pathology Dentistry
  • Orange Park, FL
  • NPI 1881750974

  Oral and Maxillofacial Surgery

  NPD (past)
• Daniel James Gesek Jr., DMD

  • Oral and Maxillofacial Surgery (Dentist)
  • Jacksonville, FL
  • NPI 1831129774
  NPD (past)
• Christopher Wright Latham, DMD

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Jacksonville, FL
  • NPI 1831353747
  NPD (past)

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

{
    "created_epoch": "1579219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1784592000000",
    "number": "1871123984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2047 PARK ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322043809",
            "telephone_number": "904-388-7665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2047 PARK ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322043809",
            "telephone_number": "904-388-7665"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1409 Kingsley Ave Ste 5",
            "address_purpose": "LOCATION",
            "city": "Orange Park",
            "state": "FL",
            "postal_code": "320734561",
            "country_code": "US",
            "telephone_number": "904-264-7383",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4232 Baymeadows Rd",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322174604",
            "country_code": "US",
            "telephone_number": "904-739-0690",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "JACKSONVILLE ORAL SURGERY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-17",
        "last_updated": "2026-07-21",
        "certification_date": "2026-07-21",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "VICTORIA",
        "authorized_official_title_or_position": "CRO",
        "authorized_official_telephone_number": "941-444-0558"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Jacksonville Operating Company LLC (American Sleep Medicine)
• Jacksonville Orthopaedic Institute Inc
• Jacksonville Orthopaedic Institute Inc
• Jacksonville Orthopaedic Institute Inc
• Jacksonville Orthopaedic Institute Inc
• Jacksonville Orthopaedic Institute Inc

• Oral and Maxillofacial Surgery (Dentist) in Jacksonville, FL
• Providers in Jacksonville, 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 Jul 21, 2026; 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.