ORAL SURGERY OF WEST AUGUSTA PC (NPI# 1538571435) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1538571435 |
Entity Type | Organization |
Organization Name | ORAL SURGERY OF WEST AUGUSTA PC |
Practice Address |
3634 Wheeler Rd Augusta GA 30909-6518 |
Practice Telephone | 7068608228 |
Practice Fax Number | 7068607222 |
Mailing Telephone | 7068608228 |
Mailing Fax Number | 7068607222 |
Enumeration Date | 2014-05-27 |
Last Update Date | 2014-05-27 |
Authorized Official Name | DR. BORIS J SIDOW (OWNER SURGEON) |
Authorized Official Telephone | 7068608228 |
Authorized Official Credential | D.D.S. |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgery | DN013478 | GA | Allopathic & Osteopathic Physicians |
State | Issuer | Identifier | Type Code |
---|---|---|---|
TRICARE ACTIVE DUTY DENTAL PLAN | 000425742 | 01 | |
GA | 000056438C | 05 | |
GA | 000056427C | 05 | |
TRICARE ACTIVE DUTY DENTAL PLAN | 002068046 | 01 | |
GA | 111331508B | 05 | |
TRICARE ACTIVE DUTY DENTAL PLAN | 000848645 | 01 |
Street Address |
3634 WHEELER RD |
City | AUGUSTA |
State | GA |
Zip Code | 30909-6518 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1548205636 | Drs. Peacock & Rafoth, P.C. | Dentist | 3634 Wheeler Rd, Augusta, GA 30909-6518 | 2006-06-20 |
1659567121 | Robert F Rafoth | Dentist | 3634 Wheeler Rd, Augusta, GA 30909-6518 | 2007-09-19 |
1205022779 | Ronald Thomas Peacock | Dentist | 3634 Wheeler Rd, Augusta, GA 30909-6518 | 2007-09-19 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1912513888 | Lauran Simpson | Behavior Technician | 1237 Augusta West Parkway, Augusta, GA 30909 | 2020-09-16 |
1487273884 | Still Perspectives Counseling LLC | Counselor | 1265 Inerstate Prwy, Suite B, Augusta, GA 30909 | 2020-04-15 |
1598397838 | Mjra Medical LLC | Psychologist | 3675 J Dewey Gray Cr Ste 300, Augusta, GA 30909 | 2020-02-05 |
1003452319 | Danny Robinson | Counselor | 2609 Commons Boulevard, Augusta, GA 30909 | 2019-11-21 |
1407498637 | Candice M Cruse | Social Worker | 2609 Commons Blvd, Augusta, GA 30909 | 2019-10-09 |
1902363385 | Mary D Jodon | Pharmacist | 3338 Wrightsboro Rd., Augusta, GA 30909 | 2019-02-21 |
1447790514 | Burn Critical Care Associates, LLC | Internal Medicine | 3614 J. Dewey Gray Circle, Bldg B., Augusta, GA 30909 | 2017-03-08 |
1124561766 | Sasha Latara Mccraw | Counselor | 7303 Palomino Court, Augusta, GA 30909 | 2016-11-30 |
1174974620 | Warren Umansky, Ph.d. | Psychologist | 302 Wheeler Executive Ctr, Augusta, GA 30909 | 2016-06-27 |
1811358955 | Theodora Mcleskey | Nurse Practitioner | 1215 George C. Wilson Drive, Augusta, GA 30909 | 2016-03-17 |
Find all providers in zip 30909 |
Taxonomy Code | 204E00000X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Oral & Maxillofacial Surgery |
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. |
Notes: Source: American College of Surgeons, 2013. www.facs.org [7/1/2013: definition added, source added, additional resources added] Additional Resources: American Board of Oral and Maxillofacial Surgery and American Association of Oral and Maxillofacial Surgeons While this is generally considered a specialty of dentistry, physicians can also be board certified as oral and maxillofacial surgeons through the American Board of Oral and Maxillofacial Surgery. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1184667370 | Scott S Derossi | Oral & Maxillofacial Surgery | 1430 John Wesley Gilbert Drive, Gc-1024, Ghsu College of Dental Medicine, Augusta, GA 30912-1001 | 2006-06-14 |
1942258397 | Henry W Ferguson | Oral & Maxillofacial Surgery | 1430 John Wesely Gilbert Drive, Gc-1024, Augusta, GA 30912-1001 | 2006-05-05 |
1225202484 | Jeffrey Nelson James | Oral & Maxillofacial Surgery | 1120 15th St, Augusta, GA 30912-5536 | 2008-04-18 |
1407878606 | Mark R Stevens | Oral & Maxillofacial Surgery | 1120 15th St, Augusta, GA 30912-0004 | 2006-07-24 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1124453337 | Ladi Doonquah | Oral & Maxillofacial Surgery | 3660 Flat Shoals Rd Ste 100, Decatur, GA 30034-1649 | 2013-09-06 |
1699040121 | Shenan Marie Bradshaw | Oral & Maxillofacial Surgery | 5505 Peachtree Dunwoody Rd Ste 660, Sandy Springs, GA 30342 | 2012-03-16 |
1720107105 | Christian Loetscher | Oral & Maxillofacial Surgery | 4205 N Point Pkwy Ste F, Alpharetta, GA 30022-8808 | 2007-03-28 |
1659460772 | William Jones Phillips | Oral & Maxillofacial Surgery | 698 Medical Park Lane, Gainesville, GA 30501 | 2006-10-12 |
1841306909 | Lawrence Matthew Marra | Oral & Maxillofacial Surgery | 3965 Holcomb Bridge Road, Suite 102, Norcross, GA 30092 | 2006-08-22 |
1861505141 | Durwood M Johnson Jr. | Oral & Maxillofacial Surgery | 1260 Hwy 54 W, Suite 200, Fayetteville, GA 30214 | 2006-08-17 |
1295791549 | Glenn Maron | Oral & Maxillofacial Surgery | 999 Peachtree St Ne, Ste 715, Atlanta, GA 30309 | 2006-04-25 |
1952363442 | Advanced Oral and Maxillofacial Surgery PC | Oral & Maxillofacial Surgery | 3535 Roswell Rd, Suite 27, Marietta, GA 30062-8826 | 2006-04-03 |
1114425964 | Gofs Stockbridge | Oral & Maxillofacial Surgery | 225 Country Club Dr, #110, Stockbridge, GA 30281 | 2018-01-26 |
1811403207 | Premier Anesthesia of Georgia LLC | Oral & Maxillofacial Surgery | 11 Upper Riverdale Rd, Riverdale, GA 30274 | 2017-12-20 |
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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.