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SOUTHERN ORAL SURGERY PC NPI 1881629392


NPI Information

NPI: 1881629392
Provider Name: SOUTHERN ORAL SURGERY PC

Former Legal Business Name: DRS GRUSKIN LUCAS & FERRARA PC

Classification: Dentist - 1223S0112X
Entity Type: Organization

Specialization: Oral and Maxillofacial Surgery

Address:
614 S 8TH ST
GRIFFIN, GA
ZIP 30224
Phone: (770) 228-1010
Get Directions

SOUTHERN ORAL SURGERY PC is an oral and maxillofacial surgery dentist in Griffin, 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. SOUTHERN ORAL SURGERY PC NPI is 1881629392. The provider is registered as an organization entity type and is a multiple single specialty group.
The provider Former Legal Business Name Is Drs Gruskin Lucas & Ferrara Pc.

The provider's business location address is:

614 S 8TH ST
GRIFFIN, GA
ZIP 30224-214
Phone: (770) 228-1010
Fax: (678) 692-0242

The provider's authorized official is Eric D Ferrara .
The authorized official title is Owner and has the following contact phone number (770) 228-1010.

The enumeration date for this NPI number is 7/12/2006 and was last updated on 10/12/2011.


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 SurgeryDN012761GEORGIANo
21223S0112XDentistOral and Maxillofacial SurgeryDN013416GEORGIAYes

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
1003109984AMEDICAIDGEORGIA
2U96963MEDICARE UPINOHIO
3178058507BMEDICAIDGEORGIA
4178058507AMEDICAIDGEORGIA

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

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