EAST GEORGIA CENTER FOR ORAL & FACIAL SURGERY LLC (NPI# 1215270970) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215270970 |
| Entity Type | Organization |
| Organization Name | EAST GEORGIA CENTER FOR ORAL & FACIAL SURGERY LLC |
| Practice Address |
613 E Grady St Statesboro GA 30458-5104 |
| Mailing Address |
1735 Peachtree St Ne Unit 328 Atlanta GA 30309 |
| Practice Telephone | 9127645435 |
| Enumeration Date | 2013-04-01 |
| Last Update Date | 2014-11-18 |
| Authorized Official Name | ASIF LALA (OWNER) |
| Authorized Official Telephone | 6152949637 |
| Authorized Official Credential | DMD, MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
DN014505 | GA | Dental Providers |
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
DN014405 | GA | Dental Providers |
| Street Address |
613 E GRADY ST |
| City | STATESBORO |
| State | GA |
| Zip Code | 30458-5104 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811911977 | Rodrigo Lorenzo Uribe | Dentist | 613 E Grady St, Statesboro, GA 30458-5104 | 2006-07-26 |
| 1568935286 | Statesboro Pediatric Dentistry, LLC | Dentist | 613 E Grady St, Statesboro, GA 30458-5104 | 2019-01-04 |
| 1144543372 | Anjali Puri Patel | Dentist | 613 E Grady St, Statesboro, GA 30458-5104 | 2010-03-02 |
| 1184946337 | East Georgia Oral & Maxillofacial Surgery Center | Clinic/Center | 613 E Grady St, Statesboro, GA 30458-5104 | 2010-02-15 |
| 1326185349 | Suketu J. Patel | Dentist | 613 E Grady St, Statesboro, GA 30458-5104 | 2007-01-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639642218 | Youtherapy | Counselor | 430 Northside Dr East, Suite 160 Mb326, Statesboro, GA 30458 | 2019-01-07 |
| 1053891853 | Alexandria Franklin | Specialist/Technologist | 1332 Southern Dr, Statesboro, GA 30458 | 2018-08-21 |
| 1740780006 | Michael Ryan Clark | Pharmacist | 556 Northside Drive, Statesboro, GA 30458 | 2018-02-13 |
| 1689186405 | Chandler James Herman | Specialist/Technologist | 590 Herty Dr., Statesboro, GA 30458 | 2017-11-02 |
| 1477009181 | Mama Doc Pediatrics, LLC | Pediatrics | 400 East Grady Street, Statesboro, GA 30458 | 2016-09-01 |
| 1053761171 | Rebekah Roessler | Specialist/Technologist | 2687 Akins Blvd, Statesboro, GA 30458 | 2016-06-20 |
| 1427412253 | Refocus Counseling and Consulting Services | Community/Behavioral Health | 4325 Country Club, 4, Statesboro, GA 30458 | 2016-04-07 |
| 1023408523 | Kacy H. Nesmith | Nurse Practitioner | 1098 Bermuda Run, Suite 6, Statesboro, GA 30458 | 2015-02-04 |
| 1760870398 | Jessica Pasternack | Specialist/Technologist | 2687 Akins Boulevard, Statesboro, GA 30458 | 2015-01-06 |
| 1922401629 | Nathan D'amico | Student in an Organized Health Care Education/Training Program | 15 W Grady Street Unit A, Statesboro, GA 30458 | 2014-10-08 |
| Find all providers in zip 30458 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811911977 | Rodrigo Lorenzo Uribe | Dentist | 613 E Grady St, Statesboro, GA 30458-5104 | 2006-07-26 |
| 1013235290 | Bulloch Oral and Maxillofacial Surgery and Dental Implant Center | Dentist | 301 Florence Ave, Statesboro, GA 30458-5138 | 2010-05-12 |
| 1336476530 | Bulloch Oral and Maxillofacial Surgery and Dental Implant Center | Dentist | 301 Florence Ave, Statesboro, GA 30458-5138 | 2009-11-09 |
| 1326185349 | Suketu J. Patel | Dentist | 613 E Grady St, Statesboro, GA 30458-5104 | 2007-01-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598370454 | Karin Davis, Dmd, PC | Dentist | 3630 Savannah Pl Ste 250, Duluth, GA 30096-6394 | 2020-09-08 |
| 1649740796 | Sandy Springs Oral Surgery, LLC | Dentist | 5555 Peachtree Dunwoody Rd Ste G56, Atlanta, GA 30342-1700 | 2018-12-02 |
| 1700354677 | Cobb Oral Surgery and Dental Implant Center PC | Dentist | 2155 Post Oak Tritt Rd Ste 500, Marietta, GA 30062-8609 | 2018-11-08 |
| 1245721216 | East Atlanta Oral, Implant and Facial Surgery Center | Dentist | 519 Memorial Dr Se Unit D1, Atlanta, GA 30312-2218 | 2018-05-24 |
| 1497261960 | Rockwell Oral and Facial Surgery LLC | Dentist | 675 N. Highland Ave Ne, Suite 100, Atlanta, GA 30306 | 2017-12-20 |
| 1225543515 | Oral & Facial Surgery of East Alabama, LLC | Dentist | 4405 N Stadium Drive, Suite A, Columbus, GA 31909 | 2017-12-08 |
| 1194271445 | Dina Amin | Dentist | 1365 Clifton,building B, Oral and Maxillofacial Surgery, Suite 2300, Atlanta, GA 30322 | 2016-08-28 |
| 1457735995 | Coastal Oral Surgery Associates | Dentist | 110 Office Park Ln, Suite 104, Saint Simons Island, GA 31522-6601 | 2015-07-15 |
| 1497140719 | Chelsea Elizabeth Johnson | Dentist | 4405 N Stadium Dr Ste A, Columbus, GA 31909-1884 | 2015-04-02 |
| 1386038396 | Timothy C Jaeger | Dentist | 1360 Caduceus Way Ste 101, Watkinsville, GA 30677-7300 | 2015-03-27 |
| Find all providers with the same taxonomy | ||||
| City | STATESBORO |
| Zip Code | 30458 |
Please comment or provide details below to improve the information on EAST GEORGIA CENTER FOR ORAL & FACIAL SURGERY LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.