NPIMap

Organization Active NPI

Obsidian Management Group LLC

  • Oral and Maxillofacial Surgery (Dentist)
  • The Woodlands, TX
National Provider Identifier
1477216620
Registry record updated Nov 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
Legal business name
OBSIDIAN MANAGEMENT GROUP LLC
Practice address
3117 College Park Dr Ste 150
The Woodlands, TX 77384-4192
Phone
(936) 231-8568
Fax
(936) 447-9738
NPI assigned
Oct 14, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2021

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

Authorized official

Name
Ms. Becky Berrill
Title
Office Manager
Phone
(936) 231-8568

Specialties & licenses 1

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

Addresses

Primary practice location

3117 College Park Dr Ste 150
The Woodlands, TX 77384-4192

Mailing address

3117 College Park Dr Ste 150
The Woodlands, TX 77384-4192
Phone (936) 231-8568

Other names 1

  • Titanium Oral, Facial & Implants Surgical Arts Doing business as

National Provider Directory

National Provider Directory

Locations

3117 College Park Dr
Ste 150
The Woodlands, TX 77384
Phone (713) 436-0148

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1634169600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635984000000",
    "number": "1477216620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3117 COLLEGE PARK DR STE 150",
            "city": "THE WOODLANDS",
            "state": "TX",
            "postal_code": "773844192",
            "telephone_number": "936-231-8568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3117 COLLEGE PARK DR STE 150",
            "city": "THE WOODLANDS",
            "state": "TX",
            "postal_code": "773844192",
            "telephone_number": "936-231-8568",
            "fax_number": "936-447-9738"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OBSIDIAN MANAGEMENT GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-14",
        "last_updated": "2021-11-04",
        "certification_date": "2021-11-04",
        "status": "A",
        "authorized_official_last_name": "BERRILL",
        "authorized_official_first_name": "BECKY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "936-231-8568",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Titanium Oral, Facial & Implants Surgical Arts",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in The Woodlands, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2021; 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.