Active NPI
Jack R. Vizuete, DDS
- Oral and Maxillofacial Surgery (Dentist)
- San Antonio, TX
National Provider Identifier
1477552925
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oral and Maxillofacial Surgery (Dentist)
- License
- 14375
- Practice address
- 7703 Floyd Curl Dr
Dept. of Oral and Maxillofacial Surgery - Mc7908
San Antonio, TX 78229-3901 - Phone
- (210) 567-3470
- Fax
- (210) 567-2995
- NPI assigned
- Jul 18, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 14375 | TX | |
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | 14375 | TX | Primary |
Addresses
Primary practice location
7703 Floyd Curl Dr
Dept. of Oral and Maxillofacial Surgery - Mc7908
San Antonio, TX 78229-3901
Mailing address
7703 Floyd Curl Dr
Dept. of Oral and Maxillofacial Surgery - Mc7908
San Antonio, TX 78229-3901
Phone (210) 567-3470
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306284-03 | Medicaid | TX | |
| 742404710 | Other | TX | TAX ID |
| D14375 | Other | TX | DELTA TX CHIPS |
| 1306284-05 | Medicaid | TX | |
| 840368 | Other | TX | UNITED CONCORDIA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121644800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1477552925",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7703 FLOYD CURL DR",
"address_2": "DEPT. OF ORAL AND MAXILLOFACIAL SURGERY - MC7908",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782293901",
"telephone_number": "210-567-3470",
"fax_number": "210-567-2995"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7703 FLOYD CURL DR",
"address_2": "DEPT. OF ORAL AND MAXILLOFACIAL SURGERY - MC7908",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782293901",
"telephone_number": "210-567-3470",
"fax_number": "210-567-2995"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VIZUETE",
"first_name": "JACK",
"middle_name": "R.",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-07-18",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "TX",
"license": "14375",
"primary": false
},
{
"code": "1223S0112X",
"taxonomy_group": "",
"desc": "Dentist, Oral and Maxillofacial Surgery",
"state": "TX",
"license": "14375",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1306284-03",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID",
"identifier": "742404710",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DELTA TX CHIPS",
"identifier": "D14375",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1306284-05",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA",
"identifier": "840368",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Antonio, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.