NPIMap

Organization Active NPI

SDS-Bill Owens Pkwy PLLC

  • General Practice Dentistry
  • Longview, TX
National Provider Identifier
1801301643
Registry record updated Dec 1, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
13770 Issued in TX
Legal business name
SDS-BILL OWENS PKWY PLLC
Practice address
2840 Bill Owens Pkwy Ste B
Longview, TX 75605-2150
Phone
(903) 759-2261
NPI assigned
Dec 1, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2017

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

Authorized official

Name
Dr. Samuel Christopher Mack, DDS
Title
Manager
Phone
(903) 236-4050

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 13770 TX Primary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 32168 TX

Addresses

Primary practice location

2840 Bill Owens Pkwy Ste B
Longview, TX 75605-2150

Mailing address

2840 Bill Owens Pkwy Ste B
Longview, TX 75605-2150
Phone (903) 759-2261

National Provider Directory

National Provider Directory
Tax ID family
SDS-3 Doctors Circle2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2840 Bill Owens Pkwy
Ste B
Longview, TX 75605
Phone (704) 582-2272

Practitioners & affiliated clinicians

Practitioners 2

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": "1512086400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1512086400000",
    "number": "1801301643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2840 BILL OWENS PKWY STE B",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756052150",
            "telephone_number": "903-759-2261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2840 BILL OWENS PKWY STE B",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756052150",
            "telephone_number": "903-759-2261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SDS-BILL OWENS PKWY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-01",
        "last_updated": "2017-12-01",
        "status": "A",
        "authorized_official_last_name": "MACK",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "903-236-4050",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "13770",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "32168",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Longview, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2017; 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.