The Center for Oral, Facial, and Implant Surgery PA

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

21182 Issued in TX

Legal business name

THE CENTER FOR ORAL, FACIAL, AND IMPLANT SURGERY PA

Practice address

2310 Highway 157 N
Suite 103
Mansfield, TX 76063-8844

Phone

(817) 477-0922

Fax

(817) 477-0910

NPI assigned

Mar 25, 2009

Last updated

Mar 25, 2009By 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

Michael Derae Sheppard, OMSNPI 1871547893

Title

President

Phone

(817) 477-0922

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

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.

• Michael Derae Sheppard, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Mansfield, TX
  • NPI 1871547893
  NPD (past) Authorized official

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

{
    "created_epoch": "1237939200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1237939200000",
    "number": "1467694208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2310 HIGHWAY 157 N",
            "address_2": "SUITE 103",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760638844",
            "telephone_number": "817-477-0922",
            "fax_number": "817-477-0910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2310 HIGHWAY 157 N",
            "address_2": "SUITE 103",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760638844",
            "telephone_number": "817-477-0922",
            "fax_number": "817-477-0910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE CENTER FOR ORAL, FACIAL, AND IMPLANT SURGERY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-25",
        "last_updated": "2009-03-25",
        "status": "A",
        "authorized_official_last_name": "SHEPPARD",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "DERAE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "817-477-0922",
        "authorized_official_credential": "OMS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TX",
            "license": "21182",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID",
            "identifier": "8F2168",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Oral and Maxillofacial Surgery (Dentist) in Mansfield, TX
• Providers in Mansfield, 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 Mar 25, 2009; 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.