NPIMap

Organization Active NPI

SDS-Bill Owens Pkwy PLLC

Doing business as SDS-#3 Doctors Circle

  • General Practice Dentistry
  • Longview, TX
National Provider Identifier
1609349612
Registry record updated Jan 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
SDS-BILL OWENS PKWY PLLC
Doing business as
SDS-#3 Doctors Circle
Practice address
3 Doctor Cir
Longview, TX 75605-5050
Phone
(903) 757-2495
Fax
(903) 757-3707
NPI assigned
Jan 3, 2019
Last updated
Jan 3, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2019

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

Authorized official

Name
Dr. Samuel Christopher Mack, DDSNPI 1730225103
Title
Manager
Phone
(903) 236-4050

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X NU Primary

Addresses

Primary practice location

3 Doctor Cir
Longview, TX 75605-5050

Mailing address

3 Doctor Cir
Longview, TX 75605-5050
Phone (903) 757-2495

Other names 1

  • SDS-#3 Doctors Circle Doing business as

National Provider Directory

National Provider Directory
Tax ID family
SDS-3 Doctors Circle2 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

3 Doctor Cir
Longview, TX 75605
Phone (903) 757-2495

Practitioners & affiliated clinicians

Practitioners 3

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": "1546473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1546473600000",
    "number": "1609349612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 DOCTOR CIR",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756055050",
            "telephone_number": "903-757-2495",
            "fax_number": "903-757-3707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 DOCTOR CIR",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756055050",
            "telephone_number": "903-757-2495",
            "fax_number": "903-757-3707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SDS-BILL OWENS PKWY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-03",
        "last_updated": "2019-01-03",
        "status": "A",
        "authorized_official_last_name": "MACK",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "903-236-4050",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SDS-#3 Doctors Circle",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Longview, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 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.