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Organization

GASTON ORAL & MAXILLOFACIAL SURGERY

Active
Other names
Gaston Oral & Maxillofacial Surgery
Organization subpart
No

Provider details

NPI number
Authorized official
DR. PHILIP LEDFORD JAMISON DDS, PA (DIRECT OWNER)
(704) 865-7603
Entity
Organization

Contact information

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

Taxonomy

Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary

Other

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
Enumeration date
08/30/2006
Last updated
02/13/2019
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