North Platte Valley Oral & Maxillofacial Surgery, P.C.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

5558 Issued in NE

Legal business name

NORTH PLATTE VALLEY ORAL & MAXILLOFACIAL SURGERY, P.C.

Practice address

416 Valley View Dr
Suite 800
Scottsbluff, NE 69361-1486

Phone

(308) 633-1760

Fax

(308) 633-1762

NPI assigned

Jul 13, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Dennis William Black, D.D.S.

Title

President

Phone

(308) 633-1760

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1386669133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "416 VALLEY VIEW DR",
            "address_2": "SUITE 800",
            "city": "SCOTTSBLUFF",
            "state": "NE",
            "postal_code": "693611486",
            "telephone_number": "308-633-1760",
            "fax_number": "308-633-1762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "416 VALLEY VIEW DR",
            "address_2": "SUITE 800",
            "city": "SCOTTSBLUFF",
            "state": "NE",
            "postal_code": "693611486",
            "telephone_number": "308-633-1760",
            "fax_number": "308-633-1762"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH PLATTE VALLEY ORAL & MAXILLOFACIAL SURGERY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BLACK",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "308-633-1760",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NE",
            "license": "5558",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.