Atlanta Oral & Facial Surgery LLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

ATLANTA ORAL & FACIAL SURGERY LLC

Practice address

1000 Johnson Ferry Rd
BLDG H
Marietta, GA 30068-2114

Phone

(770) 977-0364

Fax

(678) 483-8487

NPI assigned

Jul 9, 2006

Last updated

Mar 1, 2024By 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

Mr. Dana Leach

Title

Chief Financial Officer

Phone

(770) 977-0364

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Tax ID family

Atlanta Oral Facial Sur3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

• Atlanta Oral & Facial Surgery LLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Marietta, GA
  • NPI 1164289377
  NPD tax ID
• Atlanta Oral & Facial Surgery LLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Acworth, GA
  • NPI 1679330898
  NPD tax ID

Locations (25 of 39)

Subparts reporting this organization as parent 2

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

• Atlanta Oral & Facial Surgery LLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Marietta, GA
  • NPI 1164289377
  NPPES parent name
• Atlanta Oral & Facial Surgery LLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Acworth, GA
  • NPI 1679330898
  NPPES parent name

Practitioners 49

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.

• Henry Kime Blair, DMD

  • Oral and Maxillofacial Surgery (Dentist)
  • Marietta, GA
  • NPI 1912165721
  Medicare reassignment Care Compare group NPD
• Ryan Chaliff, DDS, MD

  • Oral and Maxillofacial Surgery (Dentist)
  • Marietta, GA
  • NPI 1861980757
  Medicare reassignment Care Compare group NPD
• David Cole, DMD

  • Oral and Maxillofacial Surgery (Dentist)
  • Fayetteville, GA
  • NPI 1558895078
  Medicare reassignment Care Compare group NPD
• Thomas J David, DDS

  • Dentist
  • Marietta, GA
  • NPI 1275702870
  Medicare reassignment Care Compare group NPD
• Lewis John Dillard, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Acworth, GA
  • NPI 1124688841
  Medicare reassignment Care Compare group NPD
• Jorge Alberto Gonzalez-Ocasio, DMD

  • Oral and Maxillofacial Surgery (Dentist)
  • Marietta, GA
  • NPI 1205192887
  Medicare reassignment Care Compare group NPD
• Chris Jo, D.M.D.

  • Oral and Maxillofacial Surgery (Dentist)
  • Marietta, GA
  • NPI 1114985389
  Medicare reassignment Care Compare group NPD
• Richard Paul Keim Jr., DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Marietta, GA
  • NPI 1750331419
  Medicare reassignment Care Compare group NPD
• Chris S Kim, DMD, MD

  • Oral and Maxillofacial Surgery (Dentist)
  • Rome, GA
  • NPI 1003293077
  Medicare reassignment Care Compare group NPD
• Christopher Hugh Kragor, MD DMD

  • Oral and Maxillofacial Surgery (Dentist)
  • Marietta, GA
  • NPI 1194082321
  Medicare reassignment Care Compare group NPD
• John Paul Labanc, D.D.S.

  • Oral and Maxillofacial Surgery (Dentist)
  • Marietta, GA
  • NPI 1104819101
  Medicare reassignment Care Compare group NPD
• Jacob Lee, DMD, MD

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Fayetteville, GA
  • NPI 1912438805

  Oral and Maxillofacial Surgery

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1152403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709251200000",
    "number": "1992738165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 JOHNSON FERRY RD",
            "address_2": "BLDG H",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300682114",
            "telephone_number": "770-977-0364",
            "fax_number": "678-483-8487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 JOHNSON FERRY RD",
            "address_2": "BLDG H",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300682114",
            "telephone_number": "770-977-0364",
            "fax_number": "678-483-8487"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATLANTA ORAL & FACIAL SURGERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-09",
        "last_updated": "2024-03-01",
        "certification_date": "2024-03-01",
        "status": "A",
        "authorized_official_last_name": "LEACH",
        "authorized_official_first_name": "DANA",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "770-977-0364",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X MULTIPLE 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 Marietta, GA
• Providers in Marietta, 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 Mar 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.