Provider Type Icon

BULLOCH ORAL AND MAXILLOFACIAL SURGERY AND DENTAL IMPLANT CENTER NPI 1013235290


NPI Information

NPI: 1013235290
Provider Name: BULLOCH ORAL AND MAXILLOFACIAL SURGERY AND DENTAL IMPLANT CENTER
Classification: Dentist - 1223S0112X
Entity Type: Organization

Specialization: Oral and Maxillofacial Surgery

Address:
301 FLORENCE AVE
STATESBORO, GA
ZIP 30458
Phone: (912) 764-7500
Get Directions

BULLOCH ORAL AND MAXILLOFACIAL SURGERY AND DENTAL IMPLANT CENTER is an oral and maxillofacial surgery dentist in Statesboro, GA. 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. BULLOCH ORAL AND MAXILLOFACIAL SURGERY AND DENTAL IMPLANT CENTER NPI is 1013235290. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

301 FLORENCE AVE
STATESBORO, GA
ZIP 30458-138
Phone: (912) 764-7500
Fax: (912) 764-7503

The provider's authorized official is Roger Lee Myers .
The authorized official title is Owner and has the following contact phone number (912) 764-7500.

The enumeration date for this NPI number is 5/12/2010 and was last updated on 5/12/2010.


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 SurgeryDN013413GEORGIAYes

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 Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1379753056CMEDICAIDGEORGIA

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: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.