Simply Dental & Oral Surgery PC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DD3399 Issued in NM

Legal business name

SIMPLY DENTAL & ORAL SURGERY PC

Practice address

4760 N Butler Ave Ste B1
Farmington, NM 87401-0816

Phone

(505) 325-8858

NPI assigned

Nov 14, 2014

Last updated

Nov 14, 2014By 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

Joseph A Wilson, DMD, MSD, LLC

Title

Owner

Phone

(505) 360-9592

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1415923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415923200000",
    "number": "1578969754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4760 N BUTLER AVE STE B1",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874010816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4760 N BUTLER AVE STE B1",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874010816",
            "telephone_number": "505-325-8858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIMPLY DENTAL & ORAL SURGERY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-14",
        "last_updated": "2014-11-14",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "505-360-9592",
        "authorized_official_credential": "DMD, MSD, LLC"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NM",
            "license": "DD3399",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Oral and Maxillofacial Surgery (Dentist) in Farmington, NM
• Providers in Farmington, NM by specialty
• Oral and Maxillofacial Surgery (Dentist) in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2014; 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.