CCOFS ORAL SURGERY 2 LLC (NPI# 1700491685) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700491685 |
| Entity Type | Organization |
| Organization Name | CCOFS ORAL SURGERY 2 LLC |
| Practice Address |
4103 E North St Greenville SC 29615-2350 |
| Mailing Address |
7482 Waterside Crossing Blvd Ste 101 Denver NC 28037-3006 |
| Practice Telephone | 8642686417 |
| Practice Fax Number | 8642683200 |
| Mailing Telephone | 7042954653 |
| Mailing Fax Number | 7042954288 |
| Enumeration Date | 2020-09-09 |
| Last Update Date | 2020-09-09 |
| Authorized Official Name | MRS. JENNIFER RAYLE HOCK (DIRECTOR OF BILLING) |
| Authorized Official Telephone | 7042954653 |
| Is Organization Subpart | Y |
| Parent Organization Name | DRS MISIEK, FARRELL, FARRELL, NALE, COOK, KAPITAN, MOHAMED & FRA |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
Dental Providers |
| Other Name | Type Code |
|---|---|
| Carolinas Center for Oral & Facial Surgery | Other Name - Individual/Organization |
| Street Address |
4103 E NORTH ST |
| City | GREENVILLE |
| State | SC |
| Zip Code | 29615-2350 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790720043 | James B Tankersley Jr. | Oral & Maxillofacial Surgery | 4103 E North St, Greenville, SC 29615 | 2006-06-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194358051 | Adenike Orogade | Behavior Technician | 17 Caldedon Ct, Suite B, Greenville, SC 29615 | 2020-02-19 |
| 1629608369 | Jennifer Jacobsen | Behavior Technician | 17 Caldedon Court, Suite B, Greenville, SC 29615 | 2020-01-22 |
| 1932668217 | Carolina Orthopaedic and Neurosurgical Associates | Orthopaedic Surgery | Carolina Orthopaedic and Neurosurgical Associates, 220 Roper Mountain Road Extension, Greenville, SC 29615 | 2019-03-18 |
| 1255816070 | Trevis L Cureton | Pharmacist | 2401 East North St, Greenville, SC 29615 | 2018-09-27 |
| 1497232565 | Jacob J Fountain | Nurse Practitioner | 225 Enterprise Blvd, Suite 101, Greenville, SC 29615 | 2018-07-23 |
| 1346726924 | St. Francis Physician Services, Inc | Internal Medicine | 5 Hoke Smith Blvd, Greenville, SC 29615 | 2018-07-17 |
| 1558853101 | Alexandra Michelle Taylor | Audiologist | 200 Patewood Dr Ste 400, Greenville, SC 29615 | 2018-05-30 |
| 1316466543 | Mariah Hope Mosher | Behavioral Analyst | 7 Mckenna Commons Court, Greenvilee, SC 29615 | 2017-09-19 |
| 1326400896 | Karen L Heaps | Counselor | 3150 S. Hwy 14, The Pelham Center, Greenville, SC 29615 | 2016-03-24 |
| 1134589013 | Sharon Erk | Technician, Other | 2950 E.norths St, Greenville, OH 29615 | 2016-03-04 |
| Find all providers in zip 29615 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| 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 |
|---|---|---|---|---|
| 1427464460 | Emerson G Crawford Jr. | Dentist | 1851 Macgregor Downs Rd # Ms 701, Ecu School of Dental Medicine, Greenville, NC 27834-5925 | 2014-07-10 |
| 1285838078 | Brian Russell Cherry | Dentist | 225 Halton Rd Ste B, Greenville, SC 29607-3499 | 2007-06-13 |
| 1821152430 | Charles Robert Means Jr. | Dentist | 410 Spring Forest Drive, Greenville, NC 27834-7244 | 2006-12-20 |
| 1912003468 | James C Wilson | Dentist | 3929 S Highway 14, Greenville, SC 29615-6138 | 2006-09-15 |
| 1346225422 | Ryland Tyrone Traynham | Dentist | 2 Pointe Cir, Greenville, SC 29615-3506 | 2005-12-12 |
| 1548252844 | R Anthony Murray | Dentist | 1805 W Arlington Blvd, Suite C, Greenville, NC 27834-5740 | 2005-08-22 |
| 1366444085 | Theodore Gabriel Muchiteni | Dentist | 2300 Hemby Ln, Greenville, NC 27834-3775 | 2005-08-12 |
| 1962401422 | Bart David Williams IIi | Dentist | 39 Brendan Way, Greenville, SC 29615-3514 | 2005-07-18 |
| 1306401948 | Carolinas Center for Dental Implants | Dentist | 280 Rocky Slope Rd, Greenville, SC 29607-3908 | 2019-05-09 |
| 1851730634 | Ashley Cannon Tankersley | Dentist | 280 Rocky Slope Rd, Greenville, SC 29607-3908 | 2013-06-14 |
| Find all providers in GREENVILLE | ||||
| City | GREENVILLE |
| Zip Code | 29615 |
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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.