# GASTON ORAL & MAXILLOFACIAL SURGERY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Gaston Oral & Maxillofacial Surgery
- **Organization subpart:** No

## Provider details

- **NPI number:** 1538279757
- **Authorized official:** DR. PHILIP LEDFORD JAMISON DDS, PA (DIRECT OWNER)
- **Authorized official phone:** (704) 865-7603

## Contact information

- **Practice address:** GASTON ORAL & MAXILLOFACIAL SURGERY, 571 COX ROAD, GASTONIA, NC 28054-0632
- **Practice address phone:** (704) 865-7603
- **Practice address fax:** (704) 865-6411
- **Mailing address:** GASTON ORAL & MAXILLOFACIAL SURGERY, 571 COX ROAD, GASTONIA, NC 28054-0632
- **Mailing address phone:** (704) 865-7603
- **Mailing address fax:** (704) 865-6411

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | — |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | — | NULL | Yes |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | — | — | Yes |

## Other

- **Enumeration date:** 08/30/2006
- **Last updated:** 02/13/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 8990868 | — | NC |
| 05 | — | 8994489 | — | NC |
| 01 | — | 90868 | BCBS PROVIDER NUMBER | NC |
| 01 | — | 94489 | BCBS PROVIDER NUMBER | NC |