NPIMap

Organization Active NPI

Olympia Hills Family Dental, PC

  • General Practice Dentistry
  • Live Oak, TX
National Provider Identifier
1619371689
Registry record updated Apr 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
25021 Issued in TX
Legal business name
OLYMPIA HILLS FAMILY DENTAL, PC
Practice address
8056 Shin Oak Dr
Ste 100
Live Oak, TX 78233
Phone
(210) 658-3131
Fax
(210) 658-9033
NPI assigned
Oct 20, 2014
Last updated
Apr 20, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2022

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

Authorized official

Name
Dr. Jerame K Hafen, DDSNPI 1497089346
Title
President/Dentist
Phone
(210) 845-8831

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 25021 TX Primary

Addresses

Primary practice location

8056 Shin Oak Dr
Ste 100
Live Oak, TX 78233

Mailing address

8056 Shin Oak Dr
Ste 100
Live Oak, TX 78233
Phone (210) 658-3131

National Provider Directory

National Provider Directory

Locations

8056 Shin Oak Dr
Ste 100
Live Oak, TX 78233
Phone (210) 658-3131

Practitioners & affiliated clinicians

Practitioners 4

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": "1413763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650412800000",
    "number": "1619371689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8056 SHIN OAK DR",
            "address_2": "STE 100",
            "city": "LIVE OAK",
            "state": "TX",
            "postal_code": "78233",
            "telephone_number": "210-658-3131",
            "fax_number": "210-658-9033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8056 SHIN OAK DR",
            "address_2": "STE 100",
            "city": "LIVE OAK",
            "state": "TX",
            "postal_code": "78233",
            "telephone_number": "210-658-3131",
            "fax_number": "210-658-9033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLYMPIA HILLS FAMILY DENTAL, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-20",
        "last_updated": "2022-04-20",
        "certification_date": "2022-04-20",
        "status": "A",
        "authorized_official_last_name": "HAFEN",
        "authorized_official_first_name": "JERAME",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRESIDENT/DENTIST",
        "authorized_official_telephone_number": "210-845-8831",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "25021",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Live Oak, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2022; 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.