NPIMap

Organization Active NPI

Tyler Oral & Facial Surgery Inc.

  • Oral and Maxillofacial Surgery (Dentist)
  • Tyler, TX
National Provider Identifier
1568654077
Registry record updated Jan 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
Legal business name
TYLER ORAL & FACIAL SURGERY INC.
Practice address
805 Turtle Creek Dr
Tyler, TX 75701-1937
Phone
(903) 592-1664
Fax
(903) 525-1099
NPI assigned
Aug 17, 2007
Last updated
Jan 23, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2023

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

Authorized official

Name
Dr. Makoto Saigusa, DMD, MDNPI 1417067497
Title
V-Pres.
Phone
(903) 592-1664

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X NU Primary
Oral & Maxillofacial Surgery (D.M.D.) 204E00000X NU

Addresses

Primary practice location

805 Turtle Creek Dr
Tyler, TX 75701-1937

Mailing address

805 Turtle Creek Dr
Tyler, TX 75701-1937
Phone (903) 592-1664

Other practice location 1

6 Doctor Cir
Longview, TX 75605-5050
Phone (903) 592-1664

Other identifiers 1

IdentifierTypeStateIssuer
195647603-01MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051220000984 TX Part B Supplier - Clinic/Group Practice 0446272306 Receives reassigned benefits from 5 practitioners
Practice locations: Lindale, TX; Longview, TX; Tyler, TX

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D1006769Tyler Oral & Facial Surgery, Inc805 Turtle Creek Drive, Tyler, TX 75701Certificate of waiverNov 26, 2026

National Provider Directory

National Provider Directory
Tax ID family
Barry G Acker DDS2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

705 E Marshall Ave
Ste 4003
Longview, TX 75601
Phone (903) 315-3810

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

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": "1187308800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674432000000",
    "number": "1568654077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 TURTLE CREEK DR",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757011937",
            "telephone_number": "903-592-1664",
            "fax_number": "903-525-1099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 TURTLE CREEK DR",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757011937",
            "telephone_number": "903-592-1664",
            "fax_number": "903-525-1099"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6 Doctor Cir",
            "address_purpose": "LOCATION",
            "city": "Longview",
            "state": "TX",
            "postal_code": "756055050",
            "country_code": "US",
            "telephone_number": "903-592-1664",
            "fax_number": "903-212-0677",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TYLER ORAL & FACIAL SURGERY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-17",
        "last_updated": "2023-01-23",
        "certification_date": "2023-01-23",
        "status": "A",
        "authorized_official_last_name": "SAIGUSA",
        "authorized_official_first_name": "MAKOTO",
        "authorized_official_title_or_position": "V-PRES.",
        "authorized_official_telephone_number": "903-592-1664",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD, MD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "195647603-01",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.