Oral & Maxillofacial Surgery of Abilene PLLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

24237 Issued in TX

Legal business name

ORAL & MAXILLOFACIAL SURGERY OF ABILENE PLLC

Practice address

1904 Pine St Ste 1D
Abilene, TX 79601-2450

Phone

(325) 232-8939

Fax

(325) 232-8943

NPI assigned

Mar 1, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Ryan Green, DDS, MD

Title

President

Phone

(325) 232-8939

Specialties & licenses 3

Addresses

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

{
    "created_epoch": "1362096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1362096000000",
    "number": "1104167055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1904 PINE ST STE 1D",
            "city": "ABILENE",
            "state": "TX",
            "postal_code": "796012450",
            "telephone_number": "325-232-8939",
            "fax_number": "325-232-8943"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1904 PINE ST STE 1D",
            "city": "ABILENE",
            "state": "TX",
            "postal_code": "796012450",
            "telephone_number": "325-232-8939",
            "fax_number": "325-232-8943"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORAL & MAXILLOFACIAL SURGERY OF ABILENE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-01",
        "last_updated": "2013-03-01",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "325-232-8939",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, MD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TX",
            "license": "24237",
            "primary": true
        },
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "TX",
            "license": "N4439",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "TX",
            "license": "N4439",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Oral and Maxillofacial Surgery (Dentist) in Abilene, TX
• Providers in Abilene, TX by specialty
• Oral and Maxillofacial Surgery (Dentist) in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 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.