Great Oaks Dentistry PA

Primary specialty

DentistTaxonomy code 122300000X

License

15682 Issued in TX

Legal business name

GREAT OAKS DENTISTRY PA

Practice address

1532 N Walnut Ave
New Brunsfels, TX 78130

Phone

(830) 625-2583

NPI assigned

Aug 24, 2006

Reactivated

Mar 31, 2021

Last updated

Mar 31, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Marshall K Warren, DDSNPI 1750547790

Title

Owner President

Phone

(830) 625-2583

Specialties & licenses 1

Addresses

Locations

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.

• Marshall K. Warren, D.D.S.

  • Dentist
  • New Braunfels, TX
  • NPI 1750547790
  NPD (past) Authorized official
• Colton Albrecht, DDS

  • Dentist
  • New Braunfels, TX
  • NPI 1023667672
  NPD (past)

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

{
    "created_epoch": "1156377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617148800000",
    "number": "1184731036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1532 N WALNUT AVE",
            "city": "NEW BRUNSFELS",
            "state": "TX",
            "postal_code": "78130",
            "telephone_number": "830-625-2583",
            "fax_number": "830-625-8299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1532 N WALNUT AVE",
            "city": "NEW BRUNSFELS",
            "state": "TX",
            "postal_code": "78130",
            "telephone_number": "830-625-2583"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT OAKS DENTISTRY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-24",
        "last_updated": "2021-03-31",
        "certification_date": "2021-03-31",
        "deactivation_date": "2019-10-22",
        "reactivation_date": "2021-03-31",
        "status": "A",
        "authorized_official_last_name": "WARREN",
        "authorized_official_first_name": "MARSHALL",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER PRESIDENT",
        "authorized_official_telephone_number": "830-625-2583",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "TX",
            "license": "15682",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2021; 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.