Provider Demographics
NPI:1124357520
Name:ORAL SURGERY PLUS, LLC
Entity Type:Organization
Organization Name:ORAL SURGERY PLUS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCCARTY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:508-692-9548
Mailing Address - Street 1:104 DEAN ST STE 103
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-5403
Mailing Address - Country:US
Mailing Address - Phone:508-692-9548
Mailing Address - Fax:508-692-9549
Practice Address - Street 1:104 DEAN ST STE 103
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-5403
Practice Address - Country:US
Practice Address - Phone:508-692-9548
Practice Address - Fax:508-692-9549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-14
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20685122300000X
MA18559241223D0004X
MA219151223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0004XDental ProvidersDentistDentist AnesthesiologistGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9903654Medicaid