Organization Active NPI

Corpus Christi Oral and Maxillofacial Surgeons PC

  • Oral and Maxillofacial Surgery (Dentist)
  • Corpus Christi, TX
National Provider Identifier
1669416475
Registry record updated Jan 10, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
Legal business name
CORPUS CHRISTI ORAL AND MAXILLOFACIAL SURGEONS PC
Practice address
5756 S Staples St F
Corpus Christi, TX 78413-3796
Phone
(361) 993-2290
Fax
(361) 992-4961
NPI assigned
Jun 15, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2013

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

Authorized official

Name
Debra Hendricks
Title
Insurance Clerk
Phone
(361) 993-2290

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X SINGLE SPECIALTY GROUP 1223S0112X Primary

Addresses

Primary practice location

5756 S Staples St F
Corpus Christi, TX 78413-3796

Mailing address

5756 S Staples St
Corpus Christi, TX 78413-3796
Phone (361) 993-2290

Other identifiers 3

IdentifierTypeStateIssuer
0811788-01MedicaidTX
G60013-1OtherTXDELTA TX CHIPS
0098105-01MedicaidTX

National Provider Directory

National Provider Directory

Locations

5756 S Staples St
Ste F
Corpus Christi, TX 78413
Phone (361) 993-2290

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1357776000000",
    "number": "1669416475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5756 S STAPLES ST",
            "city": "CORPUS CHRISTI",
            "state": "TX",
            "postal_code": "784133796",
            "telephone_number": "361-993-2290",
            "fax_number": "361-992-4961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5756 S STAPLES ST F",
            "city": "CORPUS CHRISTI",
            "state": "TX",
            "postal_code": "784133796",
            "telephone_number": "361-993-2290",
            "fax_number": "361-992-4961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORPUS CHRISTI ORAL AND MAXILLOFACIAL SURGEONS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-15",
        "last_updated": "2013-01-10",
        "status": "A",
        "authorized_official_last_name": "HENDRICKS",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_title_or_position": "INSURANCE CLERK",
        "authorized_official_telephone_number": "361-993-2290"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0811788-01",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DELTA TX CHIPS",
            "identifier": "G60013-1",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0098105-01",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Corpus Christi, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2013; 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.