Tri City Oral Surgery PLLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

TRI CITY ORAL SURGERY PLLC

Practice address

2822 NW 32ND St
Newcastle, OK 73065-6576

Phone

(405) 474-6362

Fax

(405) 513-6542

NPI assigned

May 18, 2016

Organization subpart

No

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

Authorized official

Name

Dayne Jensen, DMD

Title

Dentist

Phone

(405) 474-6362

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1463529600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463529600000",
    "number": "1366899510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2822 NW 32ND ST",
            "city": "NEWCASTLE",
            "state": "OK",
            "postal_code": "730656576",
            "telephone_number": "405-474-6362",
            "fax_number": "405-513-6542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2822 NW 32ND ST",
            "city": "NEWCASTLE",
            "state": "OK",
            "postal_code": "730656576",
            "telephone_number": "405-474-6362",
            "fax_number": "405-513-6542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI CITY ORAL SURGERY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-18",
        "last_updated": "2016-05-18",
        "status": "A",
        "authorized_official_last_name": "JENSEN",
        "authorized_official_first_name": "DAYNE",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "405-474-6362",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• V. Jerry Shepherd, M.D.
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• Oral and Maxillofacial Surgery (Dentist) in Newcastle, OK
• Providers in Newcastle, OK by specialty
• Oral and Maxillofacial Surgery (Dentist) in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2016; 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.