Dallas Oral and Maxillofacial Surgery

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

13059 Issued in TX

Legal business name

DALLAS ORAL AND MAXILLOFACIAL SURGERY

Practice address

6140 Sherry Lane
Dallas, TX 75225

Phone

(214) 363-6415

NPI assigned

Oct 8, 2010

Organization subpart

No

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

Authorized official

Name

Dr. David M Banta

Title

Owner/Dr

Phone

(214) 363-6415

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1286496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1286496000000",
    "number": "1417267451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6140 SHERRY LN",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752256301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6140 SHERRY LANE",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "75225",
            "telephone_number": "214-363-6415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DALLAS ORAL AND MAXILLOFACIAL SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-08",
        "last_updated": "2010-10-08",
        "status": "A",
        "authorized_official_last_name": "BANTA",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER/DR",
        "authorized_official_telephone_number": "214-363-6415",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TX",
            "license": "13059",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Oral and Maxillofacial Surgery (Dentist) in Dallas, TX
• Providers in Dallas, 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 Oct 8, 2010; 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.