| Oral And Facial Surgery Associates, Pc | |
|
745 Old Norcross Rd Lawrenceville GA 30045-4317 | |
| (770) 962-9515 | |
| (770) 962-2722 |
| Full Name | Oral And Facial Surgery Associates, Pc |
|---|---|
| Speciality | Dentist |
| Location | 745 Old Norcross Rd, Lawrenceville, Georgia |
| Authorized Official Name and Position | Robert E Ellis (MANAGING PARTNER) |
| Authorized Official Contact | 7709629515 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Oral And Facial Surgery Associates, Pc 745 Old Norcross Rd Lawrenceville GA 30045-4317 Ph: (770) 962-9515 | Oral And Facial Surgery Associates, Pc 745 Old Norcross Rd Lawrenceville GA 30045-4317 Ph: (770) 962-9515 |
| NPI Number | 1699780163 |
|---|---|
| Provider Enumeration Date | 07/30/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 4082677380 |
|---|---|
| Medicare Enrollment ID | O20041108000923 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699780163 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | DN009242 (Georgia) | Primary |
| Provider Name | Jess A Gardner |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1366451403 PECOS PAC ID: 6406819705 Enrollment ID: I20041111000131 |
| Provider Name | Sandeep V Pathak |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1144239203 PECOS PAC ID: 9638178619 Enrollment ID: I20061221000119 |
| Provider Name | Patrick Warren Walker |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1699937367 PECOS PAC ID: 6800020603 Enrollment ID: I20131010000830 |
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