NPIMap

Organization Active NPI

Citrus Oral and Maxillofacial Surgery PA

  • Oral and Maxillofacial Surgery (Dentist)
  • Crystal River, FL
National Provider Identifier
1447528906
Registry record updated Dec 12, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
8810 Issued in FL
Legal business name
CITRUS ORAL AND MAXILLOFACIAL SURGERY PA
Practice address
6129 W Corporate Oaks Dr
Crystal River, FL 34429-8732
Phone
(352) 795-4994
NPI assigned
Dec 12, 2011
Last updated
Dec 12, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2011

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

Authorized official

Name
Dr. Robert L Brockett, DMDNPI 1730287616
Title
Owner/President
Phone
(352) 795-4994

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X SINGLE SPECIALTY GROUP 1223S0112X 8810 FL Primary

Addresses

Primary practice location

6129 W Corporate Oaks Dr
Crystal River, FL 34429-8732

Mailing address

6129 W Corporate Oaks Dr
Crystal River, FL 34429-8732
Phone (352) 795-4994

National Provider Directory

National Provider Directory

Locations

6129 W Corporate Oaks Dr
Crystal River, FL 34429
Phone (352) 795-4994

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1323648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323648000000",
    "number": "1447528906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6129 W CORPORATE OAKS DR",
            "city": "CRYSTAL RIVER",
            "state": "FL",
            "postal_code": "344298732",
            "telephone_number": "352-795-4994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6129 W CORPORATE OAKS DR",
            "city": "CRYSTAL RIVER",
            "state": "FL",
            "postal_code": "344298732",
            "telephone_number": "352-795-4994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITRUS ORAL AND MAXILLOFACIAL SURGERY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-12",
        "last_updated": "2011-12-12",
        "status": "A",
        "authorized_official_last_name": "BROCKETT",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "352-795-4994",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "FL",
            "license": "8810",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crystal River, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2011; 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.