NPIMap

Organization Active NPI

Potomac Oral and Maxillofacial Surgery; LLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Dunkirk, MD
National Provider Identifier
1972202711
Registry record updated Mar 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
Legal business name
POTOMAC ORAL AND MAXILLOFACIAL SURGERY; LLC
Practice address
3150 W Ward Rd Ste 306
Dunkirk, MD 20754-3057
Phone
(615) 585-9364
Fax
(410) 257-2842
NPI assigned
Mar 1, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2023

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

Authorized official

Name
Dr. Wendell Gardner, DDS
Title
Oral and Maxillofacial Surgeon
Phone
(615) 585-9364

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X SINGLE SPECIALTY GROUP 1223S0112X Primary

Addresses

Primary practice location

3150 W Ward Rd Ste 306
Dunkirk, MD 20754-3057

Mailing address

3150 W Ward Rd Ste 306
Dunkirk, MD 20754-3057
Phone (410) 257-5333

Other identifiers 2

IdentifierTypeStateIssuer
1942407812MedicaidPA
1679626881MedicaidTN

National Provider Directory

National Provider Directory
Tax ID family
Potomac Oral Maxillofacial Surgery2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

NPI Registry JSON

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

{
    "created_epoch": "1677628800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677628800000",
    "number": "1972202711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3150 W WARD RD STE 306",
            "city": "DUNKIRK",
            "state": "MD",
            "postal_code": "207543057",
            "telephone_number": "410-257-5333",
            "fax_number": "410-257-2842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3150 W WARD RD STE 306",
            "city": "DUNKIRK",
            "state": "MD",
            "postal_code": "207543057",
            "telephone_number": "615-585-9364",
            "fax_number": "410-257-2842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POTOMAC ORAL AND MAXILLOFACIAL SURGERY; LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-01",
        "last_updated": "2023-03-01",
        "certification_date": "2023-03-01",
        "status": "A",
        "authorized_official_last_name": "GARDNER",
        "authorized_official_first_name": "WENDELL",
        "authorized_official_title_or_position": "ORAL AND MAXILLOFACIAL SURGEON",
        "authorized_official_telephone_number": "615-585-9364",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1942407812",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1679626881",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dunkirk, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2023; 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.