Clear Lake Oral and Maxillofacial Surgeyy, PLLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

13577 Issued in TX

Legal business name

CLEAR LAKE ORAL AND MAXILLOFACIAL SURGEYY, PLLC

Practice address

17448 Highway 3 Ste 170
Webster, TX 77598-4139

Phone

(281) 338-7700

Fax

(281) 338-7703

NPI assigned

Aug 27, 2012

Last updated

Aug 27, 2012By 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

Gholam Reza Zakhireh, DMD

Title

Manager/President

Phone

(281) 338-7700

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1346025600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1346025600000",
    "number": "1245588169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17448 HIGHWAY 3 STE 170",
            "city": "WEBSTER",
            "state": "TX",
            "postal_code": "775984139",
            "telephone_number": "281-338-7700",
            "fax_number": "281-338-7703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17448 HIGHWAY 3 STE 170",
            "city": "WEBSTER",
            "state": "TX",
            "postal_code": "775984139",
            "telephone_number": "281-338-7700",
            "fax_number": "281-338-7703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEAR LAKE ORAL AND MAXILLOFACIAL SURGEYY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-27",
        "last_updated": "2012-08-27",
        "status": "A",
        "authorized_official_last_name": "ZAKHIREH",
        "authorized_official_first_name": "GHOLAM REZA",
        "authorized_official_title_or_position": "MANAGER/PRESIDENT",
        "authorized_official_telephone_number": "281-338-7700",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TX",
            "license": "13577",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Oral and Maxillofacial Surgery (Dentist) in Webster, TX
• Providers in Webster, 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 Aug 27, 2012; 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.