Southern Oral Surgery PC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DN013416 Issued in GA

Legal business name

SOUTHERN ORAL SURGERY PC

Practice address

614 S 8TH St
Griffin, GA 30224-4214

Phone

(770) 228-1010

Fax

(678) 692-0242

NPI assigned

Jul 12, 2006

Last updated

Oct 12, 2011By 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

Dr. Eric D Ferrara, DDSNPI 1629073465

Title

Owner

Phone

(770) 228-1010

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• Drs Gruskin Lucas & Ferrara PC Former legal business name

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.

• Eric D Ferrara, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Griffin, GA
  • NPI 1629073465
  Authorized official Same address or phone
• Sanford E. Gruskin, D.D.S., M.S.D.

  • Oral and Maxillofacial Surgery (Dentist)
  • Jonesboro, GA
  • NPI 1639299704
  NPD (past)
• Edward E. Lucas, D.D.S.

  • Oral and Maxillofacial Surgery (Dentist)
  • Atlanta, GA
  • NPI 1982724092
  NPD (past)

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318377600000",
    "number": "1881629392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "614 S 8TH ST",
            "city": "GRIFFIN",
            "state": "GA",
            "postal_code": "302244214",
            "telephone_number": "770-228-1010",
            "fax_number": "678-692-0242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "614 S 8TH ST",
            "city": "GRIFFIN",
            "state": "GA",
            "postal_code": "302244214",
            "telephone_number": "770-228-1010",
            "fax_number": "678-692-0242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN ORAL SURGERY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-12",
        "last_updated": "2011-10-12",
        "status": "A",
        "authorized_official_last_name": "FERRARA",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-228-1010",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "GA",
            "license": "DN013416",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "GA",
            "license": "DN012761",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003109984A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "178058507B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "178058507A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Drs Gruskin Lucas & Ferrara PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Oral and Maxillofacial Surgery (Dentist) in Griffin, GA
• Providers in Griffin, 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 12, 2011; 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.