Implant&Maxillofacial Surgical Center

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

1993 Issued in ND

Legal business name

IMPLANT&MAXILLOFACIAL SURGICAL CENTER

Practice address

2224 1St Ave W Ste 2
Williston, ND 58801-6286

Phone

(701) 721-5254

NPI assigned

Apr 2, 2014

Last updated

Apr 2, 2014By 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. Juan J. Ulloa, DDS

Title

Oral&Maxillofacial Surgeon/Owner

Phone

(701) 721-5254

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1396396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1396396800000",
    "number": "1255759650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2224 1ST AVE W STE 2",
            "city": "WILLISTON",
            "state": "ND",
            "postal_code": "588016286",
            "telephone_number": "701-721-5254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2224 1ST AVE W STE 2",
            "city": "WILLISTON",
            "state": "ND",
            "postal_code": "588016286",
            "telephone_number": "701-721-5254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPLANT&MAXILLOFACIAL SURGICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-02",
        "last_updated": "2014-04-02",
        "status": "A",
        "authorized_official_last_name": "ULLOA",
        "authorized_official_first_name": "JUAN",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "ORAL&MAXILLOFACIAL SURGEON/OWNER",
        "authorized_official_telephone_number": "701-721-5254",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "ND",
            "license": "1993",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PERSONAL NPI",
            "identifier": "1811196504",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Oral and Maxillofacial Surgery (Dentist) in Williston, ND
• Providers in Williston, ND by specialty
• Oral and Maxillofacial Surgery (Dentist) in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2014; 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.