Central TX Oral & Maxillofacial Surgery

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

17564 Issued in TX

Legal business name

CENTRAL TX ORAL & MAXILLOFACIAL SURGERY

Practice address

2030 Heights Dr Ste 3
Harker Heights, TX 76548-2185

Phone

(254) 699-9500

Fax

(254) 699-2796

NPI assigned

Nov 13, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Lavelle Ford, D.D.S

Title

President/Owner

Phone

(254) 699-9500

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1194912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340323200000",
    "number": "1730369299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2030 HEIGHTS DR STE 3",
            "city": "HARKER HEIGHTS",
            "state": "TX",
            "postal_code": "765482185",
            "telephone_number": "254-699-9500",
            "fax_number": "254-699-2796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2030 HEIGHTS DR STE 3",
            "city": "HARKER HEIGHTS",
            "state": "TX",
            "postal_code": "765482185",
            "telephone_number": "254-699-9500",
            "fax_number": "254-699-2796"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL TX ORAL & MAXILLOFACIAL SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-13",
        "last_updated": "2012-06-22",
        "status": "A",
        "authorized_official_last_name": "FORD",
        "authorized_official_first_name": "LAVELLE",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "254-699-9500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TX",
            "license": "17564",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110929003",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110929001",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Oral and Maxillofacial Surgery (Dentist) in Harker Heights, TX
• Providers in Harker Heights, 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 22, 2012; 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.