NPIMap

Organization Active NPI

Eastern Iowa Oral and Maxillofacial Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Cedar Rapids, IA
National Provider Identifier
1992962732
Registry record updated Dec 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
08986 Issued in IA
Legal business name
EASTERN IOWA ORAL AND MAXILLOFACIAL SURGERY
Practice address
4150 Edgewood Road NE
Suite 100
Cedar Rapids, IA 52402-0609
Phone
(319) 366-8277
Fax
(319) 366-7091
NPI assigned
May 20, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2021

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

Authorized official

Name
Mrs. Suzanne J. Stewart
Title
Office Manager
Phone
(319) 366-8277

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193200000X MULTI-SPECIALTY GROUP 1223S0112X 08986 IA Primary

Addresses

Primary practice location

4150 Edgewood Road NE
Suite 100
Cedar Rapids, IA 52402-0609

Mailing address

4150 Edgewood Road NE
Suite 100
Cedar Rapids, IA 52402-0609
Phone (319) 366-8277

Other identifiers 4

IdentifierTypeStateIssuer
08986OtherIABENJAMIN L. FULLER LICENSE NUMBER
1265727150OtherIAJAROM E. MAURER NPI
1689802910OtherIABENJAMIN L. FULLER NPI
09173OtherIAJAROM E. MAURER LICENSE NUMBER

National Provider Directory

National Provider Directory

Locations

4150 Edgewood Rd NE
Ste 100
Cedar Rapids, IA 52402
Phone (319) 366-8277

Practitioners & affiliated clinicians

Practitioners 6

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": "1211241600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640649600000",
    "number": "1992962732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4150 EDGEWOOD ROAD NE",
            "address_2": "SUITE 100",
            "city": "CEDAR RAPIDS",
            "state": "IA",
            "postal_code": "524020609",
            "telephone_number": "319-366-8277",
            "fax_number": "319-366-7091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4150 EDGEWOOD ROAD NE",
            "address_2": "SUITE 100",
            "city": "CEDAR RAPIDS",
            "state": "IA",
            "postal_code": "524020609",
            "telephone_number": "319-366-8277",
            "fax_number": "319-366-7091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERN IOWA ORAL AND MAXILLOFACIAL SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-20",
        "last_updated": "2021-12-28",
        "certification_date": "2021-12-28",
        "status": "A",
        "authorized_official_last_name": "STEWART",
        "authorized_official_first_name": "SUZANNE",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "319-366-8277",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IA",
            "license": "08986",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BENJAMIN L. FULLER  LICENSE NUMBER",
            "identifier": "08986",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JAROM E. MAURER NPI",
            "identifier": "1265727150",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BENJAMIN L. FULLER  NPI",
            "identifier": "1689802910",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JAROM E. MAURER  LICENSE NUMBER",
            "identifier": "09173",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cedar Rapids, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2021; 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.