NPIMap

Organization Active NPI

Bluebonnet Oral Surgery and Implants PLLC

  • Oral and Maxillofacial Surgery (Dentist)
  • San Antonio, TX
National Provider Identifier
1033550983
Registry record updated Jul 8, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
12316 Issued in TX
Legal business name
BLUEBONNET ORAL SURGERY AND IMPLANTS PLLC
Practice address
7300 Blanco Rd
Suite 100
San Antonio, TX 78216-4936
Phone
(210) 344-9898
Fax
(210) 344-9118
NPI assigned
Jul 8, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Greg Randolph, DDS
Title
Dentist
Phone
(210) 344-9898

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X SINGLE SPECIALTY GROUP 1223S0112X 12316 TX Primary

Addresses

Primary practice location

7300 Blanco Rd
Suite 100
San Antonio, TX 78216-4936

Mailing address

7300 Blanco Rd
Suite 100
San Antonio, TX 78216-4936
Phone (210) 344-9898

Other identifiers 2

IdentifierTypeStateIssuer
12316OtherTXDENTAL LICENSE NUMBER
14522OtherTXDENTAL LICENSE NUMBER

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1373241600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1373241600000",
    "number": "1033550983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7300 BLANCO RD",
            "address_2": "SUITE 100",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782164936",
            "telephone_number": "210-344-9898",
            "fax_number": "210-344-9118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7300 BLANCO RD",
            "address_2": "SUITE 100",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782164936",
            "telephone_number": "210-344-9898",
            "fax_number": "210-344-9118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUEBONNET ORAL SURGERY AND IMPLANTS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-08",
        "last_updated": "2013-07-08",
        "status": "A",
        "authorized_official_last_name": "RANDOLPH",
        "authorized_official_first_name": "GREG",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "210-344-9898",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TX",
            "license": "12316",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE NUMBER",
            "identifier": "12316",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE NUMBER",
            "identifier": "14522",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.