Middle Georgia Oral and Maxillofacial Surgery LLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

MIDDLE GEORGIA ORAL AND MAXILLOFACIAL SURGERY LLC

Practice address

117 S Calhoun St
Dublin, GA 31021-5245

Phone

(706) 340-3408

NPI assigned

Jul 1, 2019

Last updated

Jul 1, 2019By 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. Glendon William Smalley III, DMDNPI 1336466028

Title

Oral Surgeon

Phone

(706) 340-3408

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

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.

• Glendon W Smalley III, DMD

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Dublin, GA
  • NPI 1336466028
  Authorized official Same address or phone

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

{
    "created_epoch": "1561939200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1561939200000",
    "number": "1942862859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 CREST DR",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352095525",
            "telephone_number": "478-290-7275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 S CALHOUN ST",
            "city": "DUBLIN",
            "state": "GA",
            "postal_code": "310215245",
            "telephone_number": "706-340-3408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDDLE GEORGIA ORAL AND MAXILLOFACIAL SURGERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-01",
        "last_updated": "2019-07-01",
        "status": "A",
        "authorized_official_last_name": "SMALLEY",
        "authorized_official_first_name": "GLENDON",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "ORAL SURGEON",
        "authorized_official_telephone_number": "706-340-3408",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "DN014148",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "NA",
            "affiliation": "N",
            "endpointDescription": "No computer systems/emails set up for the practice as of now.",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "NA",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "NA",
            "address_1": "117 S Calhoun St",
            "city": "Dublin",
            "state": "GA",
            "country_code": "US",
            "postal_code": "310215245",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Oral and Maxillofacial Surgery (Dentist) in Dublin, GA
• Providers in Dublin, 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 1, 2019; 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.