NPIMap

Organization Active NPI

College Station Oral Surgery, PLLC

  • Oral & Maxillofacial Surgery (D.M.D.)
  • College Station, TX
National Provider Identifier
1477101053
Registry record updated Aug 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X
Legal business name
COLLEGE STATION ORAL SURGERY, PLLC
Practice address
1645 Greens Prairie Rd W Ste 202
College Station, TX 77845-8414
Phone
(979) 316-5000
NPI assigned
Aug 28, 2019
Last updated
Aug 28, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2019

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

Authorized official

Name
Jackie Carranza
Title
General Manager
Phone
(979) 316-5000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral & Maxillofacial Surgery (D.M.D.) 204E00000X Primary

Addresses

Primary practice location

1645 Greens Prairie Rd W Ste 202
College Station, TX 77845-8414

Mailing address

24437 Katy Fwy Ste 500
Katy, TX 77494-1469
Phone (281) 394-9340

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

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": "1566950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1566950400000",
    "number": "1477101053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24437 KATY FWY STE 500",
            "city": "KATY",
            "state": "TX",
            "postal_code": "774941469",
            "telephone_number": "281-394-9340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1645 GREENS PRAIRIE RD W STE 202",
            "city": "COLLEGE STATION",
            "state": "TX",
            "postal_code": "778458414",
            "telephone_number": "979-316-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLEGE STATION ORAL SURGERY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-28",
        "last_updated": "2019-08-28",
        "status": "A",
        "authorized_official_last_name": "CARRANZA",
        "authorized_official_first_name": "JACKIE",
        "authorized_official_title_or_position": "GENERAL MANAGER",
        "authorized_official_telephone_number": "979-316-5000"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in College Station, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2019; 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.