ST AUGUSTINE ORAL & FACIAL SURGICAL CENTER PA
NPI 1629288824
Oral & Maxillofacial Surgery in St Augustine, FL

Q: What is St Augustine Oral & Facial Surgical Center PA's specialty?

The primary specialty registered for this NPI is Oral & Maxillofacial Surgery with taxonomy code 204E00000X.

Active since May 23, 2007CLIA 10D1067825 · Waiver

1301 PLANTATION ISLAND DR S, SUITE 101, ST AUGUSTINE, FL 32080(904) 460-0505(904) 460-0506 Get Directions Write a Review

NPPES record last updated: June 23, 2008. Verified against the NPPES registry weekly; last sync: August 23, 2026.

On this page

About St Augustine Oral & Facial Surgical Center Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ST AUGUSTINE ORAL & FACIAL SURGICAL CENTER PA (NPI 1629288824) is a healthcare organization registered as an oral & maxillofacial surgery in St Augustine, Florida and active in the NPI registry since May 2007. The organization holds a CLIA Waiver certificate valid through April 25, 2027 and lists Douglas L Johnson, Owner, as its authorized official.

NPPES Registry Identity

NPI1629288824

Entity TypeOrganization

Primary Taxonomy204E00000X

Legal Business NameST AUGUSTINE ORAL & FACIAL SURGICAL CENTER PA

Location Address1301 PLANTATION ISLAND DR S, SUITE 101St Augustine, FL 32080-3108

Mailing AddressPo Box 7870Springdale, AR 72766-7870 · (479) 464-5824 · Fax (479) 725-2395

Phone(904) 460-0505

Fax(904) 460-0506

Organization SubpartNo

Authorized OfficialDouglas L JohnsonOwner · (904) 460-0505

Enumeration DateMay 23, 2007

Last NPPES UpdateJune 23, 2008

✔ NPI 1629288824 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyOral & Maxillofacial SurgeryAllopathic & Osteopathic Physicians

Taxonomy Code204E00000X

License✔ Licensed in FL · DN15568

Definition

Oral and maxillofacial surgeons are trained to recognize and treat a wide spectrum of diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region. They are also trained to administer anesthesia, and provide care in an office setting. They are trained to treat problems such as the extraction of wisdom teeth, misaligned jaws, tumors and cysts of the jaw and mouth, and to perform dental implant surgery.

Also ListedDentist · Oral and Maxillofacial SurgeryTaxonomy 1223S0112X · License DN15568 (FL)

Also ListedPlastic Surgery · Plastic Surgery Within the Head and NeckTaxonomy 2082S0099X · License DN15568 (FL)

1301 PLANTATION ISLAND DR S, St Augustine, FL 32080

Open in Google Maps ↗

Other Identifiers 3

OtherDD5857FL · Railroad Medicare Group

Medicare PINK5486FL

Medicare UPINU85447FL

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 10D1067825

St Augustinge Oral And Facial Surgical Center · Saint Augustine, FL

Active · expires Apr 25, 2027

CLIA Number10D1067825

Laboratory TypePhysician Office

Certificate Effective DateApril 26, 2025

Certificate Expiration DateApril 25, 2027

Laboratory DirectorDouglas Johnson

Laboratory Phone(904) 460-0505

Laboratory LocationSt Augustinge Oral And Facial Surgical Center1301 Plantation Island Dr #101, Saint Augustine, FL 32080

CLIA data matches this NPI record on: Phone

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. MELCHOR G BARROS MD

Family Medicine

1301 PLANTATION ISLAND DR S, 102-B
ST AUGUSTINE, FL 32080

St. Johns County (904) 471-2593

RYAN J PEREIRA DPM

Podiatrist (Foot & Ankle Surgery)

1301 PLANTATION ISLAND DR S, STE 203
ST AUGUSTINE, FL 32080

St. Johns County (904) 461-0821

DR. MIGUEL A MAS JR. MD

Pediatrics

1301 PLANTATION ISLAND DR S, SUITE 404
ST AUGUSTINE, FL 32080

St. Johns County (904) 461-1560

MICHAEL HINES

Hearing Instrument Specialist

1301 PLANTATION ISLAND DR S, SUITE 401B
ST AUGUSTINE, FL 32080

St. Johns County (904) 264-0075

DR. FRANCISCO DIAZ JR. D.M.D.

Dentist (General Practice)

1301 PLANTATION ISLAND DR S, SUITE 104 B
ST AUGUSTINE, FL 32080

St. Johns County (904) 461-5566

MEDICAL PROFESSIONALS OF NORTH FLORIDA

Internal Medicine

1301 PLANTATION ISLAND DR S, SUITE 106A
SAINT AUGUSTINE, FL 32080

St. Johns County (904) 460-9191

SCOTT FORREST CORNEAL DO

Physical Medicine & Rehabilitation (Pain Medicine)

1301 PLANTATION ISLAND DR S, SUITE 402A
ST AUGUSTINE, FL 32080

St. Johns County (904) 471-4744

DR. CARMEN C VIVERO M.D.

Internal Medicine (Addiction Medicine)

1301 PLANTATION ISLAND DR S, SUITE 402-B
ST AUGUSTINE, FL 32080

St. Johns County (904) 460-0707

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is St Augustine Oral & Facial Surgical Center PA's NPI number?

The NPI number for St Augustine Oral & Facial Surgical Center PA is 1629288824. It was assigned to this organization in the NPPES registry on May 23, 2007.

Where is St Augustine Oral & Facial Surgical Center PA located?

St Augustine Oral & Facial Surgical Center PA is located at 1301 Plantation Island Dr S Suite 101, St Augustine, FL 32080. The listed phone number is (904) 460-0505.

What is St Augustine Oral & Facial Surgical Center PA's specialty?

The primary specialty registered for this NPI is Oral & Maxillofacial Surgery with taxonomy code 204E00000X.

Does St Augustine Oral & Facial Surgical Center PA hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 10D1067825) is associated with this NPI, valid through April 25, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for St Augustine Oral & Facial Surgical Center PA was last updated on June 23, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.