Northside Oral Surgery Center LLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

NORTHSIDE ORAL SURGERY CENTER LLC

Practice address

4700 Chamblee Dunwoody Rd
Atlanta, GA 30338-6054

Phone

(770) 393-8500

Fax

(770) 393-8855

NPI assigned

Feb 21, 2019

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

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

{
    "created_epoch": "1550707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1784592000000",
    "number": "1891252227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 CHAMBLEE DUNWOODY RD",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303386054",
            "telephone_number": "770-393-8500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 CHAMBLEE DUNWOODY RD",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303386054",
            "telephone_number": "770-393-8500",
            "fax_number": "770-393-8855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHSIDE ORAL SURGERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-21",
        "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": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Oral and Maxillofacial Surgery (Dentist) in Atlanta, GA
• Providers in Atlanta, 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 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.