Texas Dental Implant Center

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

TEXAS DENTAL IMPLANT CENTER

Practice address

1237 County Road 197
Jonesboro, TX 76538-1207

Phone

(910) 922-9644

NPI assigned

Oct 18, 2013

Last updated

Oct 18, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Jesse Lynn Deitz, RN, MBA

Title

Practice Director

Phone

(254) 300-8804

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1382054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1382054400000",
    "number": "1780012203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1237 COUNTY ROAD 197",
            "city": "JONESBORO",
            "state": "TX",
            "postal_code": "765381207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1237 COUNTY ROAD 197",
            "city": "JONESBORO",
            "state": "TX",
            "postal_code": "765381207",
            "telephone_number": "910-922-9644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TEXAS DENTAL IMPLANT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-18",
        "last_updated": "2013-10-18",
        "status": "A",
        "authorized_official_last_name": "DEITZ",
        "authorized_official_first_name": "JESSE",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "PRACTICE DIRECTOR",
        "authorized_official_telephone_number": "254-300-8804",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RN, MBA"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heritage Oral and Facial Surgery, PLLC
• Jonesboro Independent School District
• Shelia Joy Schwalbe

• Oral and Maxillofacial Surgery (Dentist) in Jonesboro, TX
• Providers in Jonesboro, 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 Oct 18, 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.