Lake Jackson Oral and Maxillofacial Surgery, PLLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

16829 Issued in TX

Legal business name

LAKE JACKSON ORAL AND MAXILLOFACIAL SURGERY, PLLC

Practice address

103 Abner Jackson Pkwy
Lake Jackson, TX 77566-5163

Phone

(979) 299-6878

Fax

(979) 299-6166

NPI assigned

Jan 28, 2016

Last updated

Jan 28, 2016By 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

Nathan Phillips, DDS

Title

Provider

Phone

(979) 299-6878

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Richard C Fugler, DDS , MD

  • Oral and Maxillofacial Surgery (Dentist)
  • Lake Jackson, TX
  • NPI 1609932078
  NPD (past)
• Ginger Battle Stagg, DDS

  • Pediatric Dentistry
  • Lake Jackson, TX
  • NPI 1740374636
  NPD (past)

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

{
    "created_epoch": "1453939200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1453939200000",
    "number": "1831557370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 ABNER JACKSON PKWY",
            "city": "LAKE JACKSON",
            "state": "TX",
            "postal_code": "775665163",
            "telephone_number": "979-299-6878",
            "fax_number": "979-299-6166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 ABNER JACKSON PKWY",
            "city": "LAKE JACKSON",
            "state": "TX",
            "postal_code": "775665163",
            "telephone_number": "979-299-6878",
            "fax_number": "979-299-6166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE JACKSON ORAL AND MAXILLOFACIAL SURGERY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-28",
        "last_updated": "2016-01-28",
        "status": "A",
        "authorized_official_last_name": "PHILLIPS",
        "authorized_official_first_name": "NATHAN",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "979-299-6878",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TX",
            "license": "16829",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3377855",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lake Jackson Emergency Medical Services, Inc.
• Lake Jackson Endoscopy Center, LP.
• Lake Jackson Family Dentistry PLLC
• Lake Jackson Imaging Center
• Lake Jackson Operations, LLC (Elmcroft of Lake Jackson)
• Lake Jackson Pediatric Speech PLLC
• Lake Jackson Plastic Surgery, PA
• Lake Jackson Rehabilitation and Wellness Center
• Lake Jackson Urology PA
• Shirmeen Lakhani, D.P.M.

• Oral and Maxillofacial Surgery (Dentist) in Lake Jackson, TX
• Providers in Lake Jackson, 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 Jan 28, 2016; 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.