NPIMap

Organization Active NPI

Sonora Oral & Maxillofacial Surgery Dental Group

  • Oral and Maxillofacial Surgery (Dentist)
  • Sonora, CA
National Provider Identifier
1972896785
Registry record updated May 26, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
Legal business name
SONORA ORAL & MAXILLOFACIAL SURGERY DENTAL GROUP
Practice address
940 Sylva LN
Suite K-1
Sonora, CA 95370-5969
Phone
(209) 532-5578
Fax
(209) 532-6730
NPI assigned
May 26, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 26, 2011

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

Authorized official

Name
Dr. Slim Bouchoucha, D.D.S., M.S.NPI 1275652422
Title
Doctor/Owner
Phone
(209) 532-5578

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

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

Addresses

Primary practice location

940 Sylva LN
Suite K-1
Sonora, CA 95370-5969

Mailing address

940 Sylva LN
Suite K-1
Sonora, CA 95370-5969
Phone (209) 532-5578

Other names 1

  • Sonora Oral & Maxillofacial Surgery Doing business as

National Provider Directory

National Provider Directory

Locations

940 Sylva Ln
Ste K1
Sonora, CA 95370
Phone (209) 532-5578

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1306368000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1306368000000",
    "number": "1972896785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "940 SYLVA LN",
            "address_2": "SUITE K-1",
            "city": "SONORA",
            "state": "CA",
            "postal_code": "953705969",
            "telephone_number": "209-532-5578",
            "fax_number": "209-532-6730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "940 SYLVA LN",
            "address_2": "SUITE K-1",
            "city": "SONORA",
            "state": "CA",
            "postal_code": "953705969",
            "telephone_number": "209-532-5578",
            "fax_number": "209-532-6730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SONORA ORAL & MAXILLOFACIAL SURGERY DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-26",
        "last_updated": "2011-05-26",
        "status": "A",
        "authorized_official_last_name": "BOUCHOUCHA",
        "authorized_official_first_name": "SLIM",
        "authorized_official_title_or_position": "DOCTOR/OWNER",
        "authorized_official_telephone_number": "209-532-5578",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S., M.S."
    },
    "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": "Sonora Oral & Maxillofacial Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sonora, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2011; 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.