The Center for Functional & Aesthetic Facial Surgery

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

9900887 Issued in NC

Legal business name

THE CENTER FOR FUNCTIONAL & AESTHETIC FACIAL SURGERY

Practice address

5501 Fortunes Ridge Dr
Suite G
Durham, NC 27713-6102

Phone

(919) 419-9222

Fax

(919) 419-9255

NPI assigned

Nov 29, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Jennifer Thomas Pickett

Title

Patient Care Coordinator

Phone

(919) 419-9222

Specialties & licenses 1

Addresses

Other names 1

• Jeffrey S. Jelic, DMD, MD Other name

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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.

• Jeffrey Jelic, MD

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Durham, NC
  • NPI 1750317178
  NPD (past)

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

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1881761583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5501 FORTUNES RIDGE DR",
            "address_2": "SUITE G",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277136102",
            "telephone_number": "919-419-9222",
            "fax_number": "919-419-9255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5501 FORTUNES RIDGE DR",
            "address_2": "SUITE G",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277136102",
            "telephone_number": "919-419-9222",
            "fax_number": "919-419-9255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE CENTER FOR FUNCTIONAL & AESTHETIC FACIAL SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PICKETT",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "PATIENT CARE COORDINATOR",
        "authorized_official_telephone_number": "919-419-9222",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NC",
            "license": "9900887",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jeffrey S. Jelic, DMD, MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• The Beauty of Wellness, LLC (The Beauty of Wellness)
• The Birch Center
• The Bridge Consulting Group, LLC
• The Carolina Center for Music Therapy, LLC
• The Cataract Vision Insitute LLC
• The Chariot Group LLC (DBA The Chariot Home Care Services)
• The Cove Restorative Psychiatry and Wellness, PLLC
• The Durham Family Group Home 'Lodge Street House'
• The Empress Haven, PLLC
• The Exchange Clubs Child Abuse Prevention Center in Durham, Inc.

• Oral and Maxillofacial Surgery (Dentist) in Durham, NC
• Providers in Durham, NC by specialty
• Oral and Maxillofacial Surgery (Dentist) in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.