THE CENTER FOR FUNCTIONAL & AESTHETIC FACIAL SURGERY (NPI# 1881761583) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1881761583 |
| Entity Type | Organization |
| Organization Name | THE CENTER FOR FUNCTIONAL & AESTHETIC FACIAL SURGERY |
| Other Organization Name | JEFFREY S. JELIC, DMD, MD |
| Practice Address |
5501 Fortunes Ridge Dr Suite G Durham NC 27713-6102 |
| Practice Telephone | 9194199222 |
| Practice Fax Number | 9194199255 |
| Mailing Telephone | 9194199222 |
| Mailing Fax Number | 9194199255 |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MRS. JENNIFER THOMAS PICKETT (PATIENT CARE COORDINATOR) |
| Authorized Official Telephone | 9194199222 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
9900887 | NC | Dental Providers |
| Other Name | Type Code |
|---|---|
| Jeffrey S. Jelic, DMD, MD | Other Name - Individual/Organization |
| Street Address |
5501 FORTUNES RIDGE DR SUITE G |
| City | DURHAM |
| State | NC |
| Zip Code | 27713-6102 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255967139 | Christopher Allen Winans | Chiropractor | 5501 Fortunes Ridge Dr, Durham, NC 27713-6102 | 2020-03-23 |
| 1073149969 | Winans Chiropractic, Pllc | Chiropractor | 5501 Fortunes Ridge Dr, Durham, NC 27713-6102 | 2020-03-23 |
| 1376093906 | Performax Physical Therapy and Sports Rehabilitation, LLC | Clinic/Center | 5501 Fortunes Ridge Dr, Ste. L, Durham, NC 27713-6102 | 2016-10-06 |
| 1215384730 | Jenn Vrieze | Behavioral Analyst | 5501 Fortunes Ridge Dr, Suite H, Durham, NC 27713-6102 | 2016-05-16 |
| 1477928620 | Katherine Charlotte Okoniewski | Psychologist | 5501 Fortunes Ridge Dr, Suite H, Durham, NC 27713-6102 | 2015-12-13 |
| 1477973394 | Erika Gagnon | Audiologist | 5501 Fortunes Ridge Dr, Ste. A, Durham, NC 27713-6102 | 2014-04-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558977074 | Zoe Wellness | Clinic/Center | 5322 Nc 55, 102, Durham, NC 27713 | 2020-09-21 |
| 1194352542 | Mariah Davis | Counselor | 1822 East Hwy Nc 54, Suite 300, Durham, NC 27713 | 2020-03-25 |
| 1316589138 | Monarch | Community/Behavioral Health | 1513 Piperwood Court, Durham, NC 27713 | 2019-10-14 |
| 1205486081 | Lisa Mesmer Barnes | Nurse Practitioner | 5309hwy 55, Suite 105, Durham, NC 27713 | 2019-09-13 |
| 1497315352 | Mary Therese Wood | Social Worker | 1822 E Highway 54, Suite 300, Durham, NC 27713 | 2019-06-13 |
| 1720558307 | Kevin D Simmons | Counselor | 1822 Nc Hwy 54 Suite 300, Durham, NC 27713 | 2018-11-27 |
| 1790265585 | Kelli Cryer | Counselor | 54 E Nc Hwy 1822, Suite 300, Durham, NC 27713 | 2018-08-21 |
| 1477039253 | Mahavir Rx, LLC | Pharmacy | 6216 Fayetteville Rd Ste 105, Durham, NC 27713 | 2018-07-16 |
| 1811482862 | Tessa Taylor | Dentist | 2515 E Nc Highway 54 Ste 2000, Durham, NC 27713 | 2018-06-22 |
| 1013401579 | Emily Louise Haller | Counselor | 1822 E Hwy 54, Suite 300, Durham, NC 27713 | 2018-06-19 |
| Find all providers in zip 27713 | ||||
| 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 |
|---|---|---|---|---|
| 1699263137 | John Breeze | Dentist | Duke University Medical Centre, Durham, NC 27710-0001 | 2018-04-30 |
| 1043413867 | North Carolina Center for Oral & Maxillofacial Surgery | Dentist | 415 -b Dunstan, Durham, NC 27707-2321 | 2007-06-08 |
| 1376691584 | David M. Lambert, Dds, Pa | Dentist | 5015 Southpark Dr Ste 120, Durham, NC 27713-7736 | 2007-01-07 |
| 1306920467 | Marthaann Keels | Dentist | 2711 N Duke St Ste A, Durham, NC 27704-2619 | 2006-10-25 |
| 1174568174 | David E Sheinkopf | Dentist | 127 Gadwall Ln, Durham, NC 27703-8377 | 2006-06-17 |
| 1356349591 | Oral & Maxillofacial Surgery Associates Pa | Dentist | 2823 N Duke St, Durham, NC 27704-2621 | 2005-07-12 |
| 1457356057 | Alexander Youngwhan Kim | Dentist | 5318 Nc Highway 55 Ste 106, Durham, NC 27713-9660 | 2005-06-20 |
| 1154724169 | Nicholas Mueller | Dentist | 5318 Nc Highway 55 Ste 106, Durham, NC 27713 | 2014-10-03 |
| 1801173034 | Spencer B. Howard D.d.s | Dentist | 2003 E Nc Highway 54, Durham, NC 27713-2482 | 2011-11-16 |
| 1639450869 | Uday N Reebye, Md, Dmd Pa | Dentist | 5318 Nc Highway 55, Suite 106, Durham, NC 27713 | 2011-09-01 |
| Find all providers in DURHAM | ||||
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| 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.