Brent T. Black, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

36416 Issued in TX

Practice address

1505 Emerald PLZ
College Station, TX 77845-1501

Phone

(979) 764-7101

NPI assigned

Apr 9, 2020

Last updated

Jul 15, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Maxillofacial Surgery

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Brazos Valley Oms PLLCGroup PAC ID 3173943651, 5 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Brazos Valley Oms PLLC

  dba Brazos Valley Oral & Maxillofacial Surgery

  • Dentist
  • College Station, TX
  • NPI 1194931303

  Oral and Maxillofacial Surgery

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1586390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721001600000",
    "number": "1144849365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1505 EMERALD PLZ",
            "city": "COLLEGE STATION",
            "state": "TX",
            "postal_code": "778451501",
            "telephone_number": "979-764-7101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 EMERALD PLZ",
            "city": "COLLEGE STATION",
            "state": "TX",
            "postal_code": "778451501",
            "telephone_number": "979-764-7101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "BRENT",
        "middle_name": "T.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-04-09",
        "last_updated": "2024-07-15",
        "certification_date": "2024-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TX",
            "license": "36416",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Crystal Louise Bigley, MS, LPC
• Sameer Bilal, DDS
• Paul David Rocky Bilhartz, M.D., M.B.A.
• Rebecca Bischoff
• Valerie Lee Bivona, CRNA
• Brian Scott Black, D.D.S.
• Jamilia Blake, PH.D.
• Aniki Blanchard, LCDC
• Jennifer J Blasingame, M.D.
• Alexandra Blazek

• Oral and Maxillofacial Surgery (Dentist) in College Station, TX
• Providers in College Station, 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 Jul 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.