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ORAL SURGERY OF WEST AUGUSTA PC NPI 1538571435


NPI Information

NPI: 1538571435
Provider Name: ORAL SURGERY OF WEST AUGUSTA PC
Classification: Oral & Maxillofacial Surgery - 204E00000X
Entity Type: Organization
Address:
3634 WHEELER RD
AUGUSTA, GA
ZIP 30909
Phone: (706) 860-8228
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ORAL SURGERY OF WEST AUGUSTA PC is an oral maxillofacial surgery in Augusta, GA. The provider is oral and maxillofacial surgeons are trained to recognize and treat a wide spectrum of diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region. They are also trained to administer anesthesia, and provide care in an office setting. They are trained to treat problems such as the extraction of wisdom teeth, misaligned jaws, tumors and cysts of the jaw and mouth, and to perform dental implant surgery. ORAL SURGERY OF WEST AUGUSTA PC NPI is 1538571435. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

3634 WHEELER RD
AUGUSTA, GA
ZIP 30909-518
Phone: (706) 860-8228
Fax: (706) 860-7222

The provider's authorized official is Boris J Sidow .
The authorized official title is Owner Surgeon and has the following contact phone number (706) 860-8228.

The enumeration date for this NPI number is 5/27/2014 and was last updated on 5/27/2014.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1204E00000XOral & Maxillofacial SurgeryDN013478GEORGIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
170055919DAMEDICARE PINGEORGIA
2000425742OTHERTRICARE ACTIVE DUTY DENTAL PLAN
3000056438CMEDICAIDGEORGIA
4U21367MEDICARE UPIN
5002068046OTHERTRICARE ACTIVE DUTY DENTAL PLAN
670056119DAMEDICARE PIN
7000056427CMEDICAIDGEORGIA
8000848645OTHERTRICARE ACTIVE DUTY DENTAL PLAN
9U21368MEDICARE UPIN
10202I195418MEDICARE PINGEORGIA
11111331508BMEDICAIDGEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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