Live Oak Oral Surgery of Texas PLLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

LIVE OAK ORAL SURGERY OF TEXAS PLLC

Practice address

2708 Southwest Pkwy Ste 130
Wichita Falls, TX 76308-3735

Phone

(580) 699-3131

Fax

(580) 699-3151

NPI assigned

Apr 25, 2019

Organization subpart

No

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

Authorized official

Name

Michael J Gliddon, DDSNPI 1285604553

Title

Owner/Oral Surgeon

Phone

(580) 699-3131

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael John Gliddon, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Lawton, OK
  • NPI 1285604553
  NPD (past) Authorized official

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

{
    "created_epoch": "1556150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1556150400000",
    "number": "1649834680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2708 SOUTHWEST PKWY STE 130",
            "city": "WICHITA FALLS",
            "state": "TX",
            "postal_code": "763083735",
            "telephone_number": "580-699-3131",
            "fax_number": "580-699-3151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2708 SOUTHWEST PKWY STE 130",
            "city": "WICHITA FALLS",
            "state": "TX",
            "postal_code": "763083735",
            "telephone_number": "580-699-3131",
            "fax_number": "580-699-3151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVE OAK ORAL SURGERY OF TEXAS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-25",
        "last_updated": "2019-04-25",
        "status": "A",
        "authorized_official_last_name": "GLIDDON",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER/ORAL SURGEON",
        "authorized_official_telephone_number": "580-699-3131",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Africa R Logan, MA, LPC
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• Oral and Maxillofacial Surgery (Dentist) in Wichita Falls, TX
• Providers in Wichita Falls, 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 Apr 25, 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.