Provider Demographics
NPI:1861807646
Name:FACIAL & ORAL SURGICAL SOLUTIONS, PLLC
Entity type:Organization
Organization Name:FACIAL & ORAL SURGICAL SOLUTIONS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STONE
Authorized Official - Middle Name:RANGARAJAN
Authorized Official - Last Name:THAYER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:386-837-1236
Mailing Address - Street 1:400 TREEMONT DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-7978
Mailing Address - Country:US
Mailing Address - Phone:386-837-1236
Mailing Address - Fax:386-960-7636
Practice Address - Street 1:400 TREEMONT DR
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-7978
Practice Address - Country:US
Practice Address - Phone:386-837-1236
Practice Address - Fax:386-960-7636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 204691223S0112X
FLDN 134691223S0112X
FLDH 17491124Q00000X
FLME 1145242082S0099X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Single Specialty
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and NeckGroup - Single Specialty