Indian Land Oral & Facial Surgery LLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

INDIAN LAND ORAL & FACIAL SURGERY LLC

Doing business as

Greater Charlotte Oral & Facial Surgery

Practice address

9787 Charlotte Hwy
Fort Mill, SC 29707-8103

Phone

(980) 939-1400

NPI assigned

Jun 15, 2018

Organization subpart

No

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

Authorized official

Name

Lesley Coyner

Title

Credentialing

Phone

(304) 720-7819

Specialties & licenses 1

Addresses

Other names 1

• Greater Charlotte Oral & Facial Surgery Doing business as

Locations

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

{
    "created_epoch": "1529020800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529020800000",
    "number": "1942794789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9789 CHARLOTTE HWY STE 400-207",
            "city": "FORT MILL",
            "state": "SC",
            "postal_code": "297077177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9787 CHARLOTTE HWY",
            "city": "FORT MILL",
            "state": "SC",
            "postal_code": "297078103",
            "telephone_number": "980-939-1400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIAN LAND ORAL & FACIAL SURGERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-15",
        "last_updated": "2018-06-15",
        "status": "A",
        "authorized_official_last_name": "COYNER",
        "authorized_official_first_name": "LESLEY",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "304-720-7819"
    },
    "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": [
        {
            "organization_name": "Greater Charlotte Oral & Facial Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Oral and Maxillofacial Surgery (Dentist) in Fort Mill, SC
• Providers in Fort Mill, SC by specialty
• Oral and Maxillofacial Surgery (Dentist) in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2018; 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.