# GATEWAY ORAL SURGERY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Gateway Oral Surgery
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073336483
- **Authorized official:** DR. ROGER MYERS DMD (OWNER)
- **Authorized official phone:** (904) 200-4375

## Contact information

- **Practice address:** 180 CAPULET DR STE 3, SAINT AUGUSTINE, FL 32092-4541
- **Practice address phone:** (904) 299-2942
- **Practice address fax:** (904) 299-2943
- **Mailing address:** 180 CAPULET DR STE 3, SAINT AUGUSTINE, FL 32092-4541
- **Mailing address phone:** (904) 299-2942
- **Mailing address fax:** (904) 299-2943

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 11/04/2024
- **Last updated:** 02/12/2025