Texas Wisdom Teeth & Dental Implants

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

TEXAS WISDOM TEETH & DENTAL IMPLANTS

Practice address

14856 Preston Rd Ste 104
Dallas, TX 75254-6844

Phone

(972) 960-1111

NPI assigned

Jun 17, 2016

Organization subpart

No

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

Authorized official

Name

David Kotliar

Title

Manager

Phone

(631) 365-3268

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1466121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466121600000",
    "number": "1629428941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14856 PRESTON RD STE 104",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752546844",
            "telephone_number": "972-960-1111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14856 PRESTON RD STE 104",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752546844",
            "telephone_number": "972-960-1111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TEXAS WISDOM TEETH & DENTAL IMPLANTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-17",
        "last_updated": "2016-06-17",
        "status": "A",
        "authorized_official_last_name": "KOTLIAR",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "631-365-3268"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Oral and Maxillofacial Surgery (Dentist) in Dallas, TX
• Providers in Dallas, TX by specialty
• Oral and Maxillofacial Surgery (Dentist) in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2016; 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.