AFFILIATED ORAL AND MAXILLOFACIAL SURGEONS P.A. — NPI 1366676553 (Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD) in EXCELSIOR, MN)

CMS-1500 Box 24J / 33a • NPI

1366676553

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

1223S0112X (CMS 19)

Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)

Box 32 Service Location & ZIP+4

348 2ND ST, SUITE 150, EXCELSIOR, MN, 55331-1830

✓ 9-Digit EDI 837 ZIP+4 (55331-1830)

Practice Phone & Referral Fax

(952) 474-6336

Fax: (952) 474-2468

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1366676553 (AFFILIATED ORAL AND MAXILLOFACIAL SURGEONS P.A.) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1366676553` (NPI-2 Organization / Facility)
Provider / Legal Name	AFFILIATED ORAL AND MAXILLOFACIAL SURGEONS P.A.
Plain-English Specialty	Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD) NUCC Code: `1223S0112X` (Dentist, Oral and Maxillofacial Surgery)
Certifying / Licensing Body	American Dental Association (ADA) / State Board of Dental Examiners
Practice Location Address	348 2ND ST, SUITE 150, EXCELSIOR, MN, 55331-1830
Practice Telephone / Fax	Tel: (952) 474-6336 \| Fax: (952) 474-2468
Administrative Mailing Address	348 2ND ST, EXCELSIOR, MN, 55331-1830
Enumeration & Last Sync	Enumerated: 2009-05-04 \| CMS Record Updated: 2009-05-04
Authorized Official	DOUGLAS CARTER (Owner/Partner)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

348 2ND ST, SUITE 150, EXCELSIOR, MN, 55331-1830

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Plain-English Taxonomy & CMS Crosswalk (1223S0112X)

What Does Taxonomy Code 1223S0112X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 1223S0112X translates to:
"Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 19 (Oral Surgery (Dentist only))
Certifying / Accrediting Authority: American Dental Association (ADA) / State Board of Dental Examiners
Clinical Scope: Routine 6-month dental checkups, toothache, dental abscess, bleeding gums (periodontitis), or wisdom tooth extraction.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (AFFILIATED ORAL AND MAXILLOFACIAL SURGEONS P.A.)

Typical CPT / Diagnostic Procedures:

Comprehensive Oral Evaluation, Digital Dental Radiographs & Prophylaxis
Restorative Composite Fillings, Crowns, Endodontic Root Canal & Extractions

Common Therapeutic Classes:

Amoxicillin, Metronidazole & Clindamycin (Odontogenic Infections)
Chlorhexidine Gluconate 0.12% Oral Rinse & High-Fluoride Varnish

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`1223S0112X` — Dentist, Oral and Maxillofacial Surgery Plain English: Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

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AFFILIATED ORAL AND MAXILLOFACIAL SURGEONS P.A. (NPI #1366676553)