GATEWAY ORAL SURGERY NPI 1073336483

NPI Information

  • NPI: 1073336483
  • Provider Name: GATEWAY ORAL SURGERY
  • Classification: Dentist - 1223S0112X
  • Specialization: Oral and Maxillofacial Surgery
  • Entity Type: Organization
  • :
  • Address: 180 CAPULET DR STE 3
    SAINT AUGUSTINE, FL
    ZIP 32092
  • Phone: (904) 299-2942

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NPI Details

GATEWAY ORAL SURGERY is an oral and maxillofacial surgery dentist in Saint Augustine, FL. The provider is an oral and maxillofacial surgery dentist specialized in 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. GATEWAY ORAL SURGERY NPI is 1073336483. The provider is registered as an organization entity type and is a single specialty group.
The provider .

The provider's business location address is:

180 CAPULET DR STE 3
SAINT AUGUSTINE, FL
ZIP 32092-541
Phone: (904) 299-2942
Fax: (904) 299-2943

The provider's authorized official is Roger Myers .
The authorized official title is Owner and has the following contact phone number (904) 200-4375.

The enumeration date for this NPI number is 11/4/2024 and was last updated on 2/12/2025.

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 Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223S0112XDentistOral and Maxillofacial SurgeryYes

What is NPI?

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This page was last updated on: 3/30/2025

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