1497261960 NPI number — ROCKWELL ORAL AND FACIAL SURGERY LLC

Table of content: (NPI 1497261960)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497261960 NPI number — ROCKWELL ORAL AND FACIAL SURGERY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROCKWELL ORAL AND FACIAL SURGERY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497261960
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/20/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
675 N. HIGHLAND AVE NE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-732-9413
Provider Business Mailing Address Fax Number:
404-500-5483

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
675 N. HIGHLAND AVE NE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-732-9413
Provider Business Practice Location Address Fax Number:
404-500-5483
Provider Enumeration Date:
12/20/2017

Additional Information

Authorized Official

Authorized Official Last Name:
ROCKWELL
Authorized Official First Name:
DAMION
Authorized Official Middle Name:
Authorized Official Title or Position:
ORAL AND MAXILLOFACIAL SURGEON
Authorized Official Telephone Number:
229-392-3897

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 204E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com