Black Hills Oral & Maxillofacial Surgery PC

Primary specialty

Oral and Maxillofacial Pathology DentistryTaxonomy code 1223P0106X

License

M367 Issued in SD

Legal business name

BLACK HILLS ORAL & MAXILLOFACIAL SURGERY PC

Practice address

3415 5TH St
Rapid City, SD 57701-7365

Phone

(605) 348-6818

Fax

(605) 348-4690

NPI assigned

Feb 15, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Roger Cave Wilson, DDS, MS

Title

President

Phone

(605) 348-6818

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Cody Christensen, D.D.S.

  • Oral and Maxillofacial Surgery (Dentist)
  • Rapid City, SD
  • NPI 1205176401
  NPD
• Erick M Rath, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Pierre, SD
  • NPI 1760576896
  NPD (past)
• Ryan M George, D.M.D.

  • Oral and Maxillofacial Surgery (Dentist)
  • Fort Riley, KS
  • NPI 1871973438
  NPD (past)

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

{
    "created_epoch": "1139961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1063486926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5690",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577095690",
            "telephone_number": "605-348-6818",
            "fax_number": "605-348-4690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3415 5TH ST",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577017365",
            "telephone_number": "605-348-6818",
            "fax_number": "605-348-4690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACK HILLS ORAL & MAXILLOFACIAL SURGERY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "ROGER",
        "authorized_official_middle_name": "CAVE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "605-348-6818",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, MS"
    },
    "taxonomies": [
        {
            "code": "1223P0106X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Pathology",
            "state": "SD",
            "license": "M367",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8000140",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8000050",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Black Hills Neuropsychology and Behavioral Health, LLC
• Black Hills Neuropsychology LLC
• Black Hills Obstetrics & Gynecology LLC
• Black Hills Obstetrics and Gynecology LLP
• Black Hills Optometry LLC
• Black Hills Oral Surgery and Dental Implant Center, LLP
• Black Hills Orthodontics, Prof. L.L.C.
• Black Hills Orthodontics, Prof. L.L.C.
• Black Hills Orthodontics, Prof. L.L.C.
• Black Hills Orthopedic & Spine Center, Inc.

• Oral and Maxillofacial Pathology Dentistry in Rapid City, SD
• Providers in Rapid City, SD by specialty
• Oral and Maxillofacial Pathology Dentistry in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.