EASTERN SHORE ORAL, FACIAL AND IMPLANT SURGERY CENTER, P.C. (NPI# 1568985349) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568985349 |
| Entity Type | Organization |
| Organization Name | EASTERN SHORE ORAL, FACIAL AND IMPLANT SURGERY CENTER, P.C. |
| Practice Address |
24172 4th Street Fairhope AL 36532 |
| Practice Telephone | (251) 333-1700 |
| Practice Fax Number | 2513331701 |
| Mailing Telephone | 2513331700 |
| Mailing Fax Number | 2513331701 |
| Enumeration Date | 2017-07-24 |
| Last Update Date | 2017-07-24 |
| Authorized Official Name | RICHARD CORDERO (OWNER/ SURGEON) |
| Authorized Official Telephone | 2513331700 |
| Authorized Official Credential | DMD, MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QS0112X |
Clinic/Center Specialization: Oral and Maxillofacial Surgery |
6357 | AL | Ambulatory Health Care Facilities |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Alabama Business Registrations | Eastern Shore Oral, Facial And Implant Surgery Center, P.C. | 7336 Wilkins Creek Ct, Spanish Fort, AL 36527 |
| Street Address |
24172 4TH STREET |
| City | FAIRHOPE |
| State | AL |
| Zip Code | 36532 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376000729 | Abby Stockman | Marriage & Family Therapist | 372 S. Greeno Road, Fairhope, AL 36532 | 2019-02-21 |
| 1962973990 | Pain Consultants of Alabama | Non-Pharmacy Dispensing Site | 320 North Greeno Rd., Fairhope, AL 36532 | 2018-12-17 |
| 1881182236 | Interface Medical Consulting LLC | Family Medicine | 12141 Cri, Fairhope, AL 36532 | 2018-05-01 |
| 1063937167 | Julia W Stone, LLC | Counselor | 21180 Al State Hwy 181, Suite 2, Fairhope, AL 36532 | 2017-08-09 |
| 1205209509 | Comfort Care Coastal Hospice, LLC | Hospice Care, Community Based | 22502 U.S. Highway 98, Fairhope, AL 36532 | 2015-11-09 |
| 1609248632 | Sabrina Reeves | Physician Assistant | 77 Magnolia Ave, Fairhope, AL 36532 | 2015-10-29 |
| 1386025146 | Laura Lasecki Wimmer | Podiatrist | 23937 Us Highway 98 Ste 1, Fairhope, AL 36532 | 2015-06-17 |
| 1386024719 | Gulf Coast Homecare LLC Dba Firstlight Homecare of Mobile Eastern Shor | In Home Supportive Care | 924 Plantation Blvd., Suite C, Fairhope, AL 36532 | 2015-06-01 |
| 1386021525 | June Lassiter | Nurse Practitioner | 22823 Ecor Rouge Lane, Fairhope, AL 36532 | 2015-04-27 |
| 1790106607 | Monica Carmen Chiang | Internal Medicine | 300 South Greeno Road, Suite B, Fairhope, AL 36532 | 2013-12-18 |
| Find all providers in zip 36532 | ||||
| Taxonomy Code | 261QS0112X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes 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. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396246906 | David Ashley Oral & Maxillofacial Surgery | Clinic/Center | 2045 Brookwood Medical Ctr Dr Ste 24, Birmingham, AL 35209-6809 | 2018-02-28 |
| 1356606461 | Mclain Surgical Arts | Clinic/Center | 2045 Cecil Ashburn Dr Se, Suite 101, Huntsville, AL 35802-2563 | 2012-07-05 |
| 1972716710 | Maxillofacial Surgery Center of Huntsville, Inc. | Clinic/Center | 1107 Gleneagles Dr Sw, Huntsville, AL 35801-6405 | 2007-05-08 |
| 1720129307 | Albert E. Willis, D.m.d., M.d., P.C. | Clinic/Center | 540 Hughes Rd, Suite 6, Madison, AL 35758-8999 | 2007-02-08 |
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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.