East Texas Oral & Maxillofacial Surgery Associates Inc.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

10700 Issued in TX

Legal business name

EAST TEXAS ORAL & MAXILLOFACIAL SURGERY ASSOCIATES INC.

Practice address

3004 H G Moseley Pkwy
Longview, TX 75605-2948

Phone

(903) 758-3444

Fax

(903) 758-1967

NPI assigned

Jan 8, 2007

Last updated

Mar 20, 2012By 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

Charlotte Marie Wilks

Title

Office Manager

Phone

(903) 758-3444

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 5

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.

• Simon Lucas Mack, D.D.S.

  • Dentist
  • Longview, TX
  • NPI 1639676166
  Medicare reassignment Care Compare group NPD
• Nathan Yang

  • Oral and Maxillofacial Surgery (Dentist)
  • Longview, TX
  • NPI 1679935076
  Medicare reassignment Care Compare group NPD
• James Andrew Mack, DDS

  • Dentist
  • Longview, TX
  • NPI 1073606281
  Medicare reassignment Care Compare group
• Christopher James Johnson, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Dallas, TX
  • NPI 1760828370
  Medicare reassignment
• Robert L Cooper, D.D.S.

  • Oral and Maxillofacial Surgery (Dentist)
  • Mount Pleasant, TX
  • NPI 1649318783
  NPD (past)

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332201600000",
    "number": "1952459307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3004 H G MOSELEY PKWY",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756052948",
            "telephone_number": "903-758-3444",
            "fax_number": "903-758-1967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3004 H G MOSELEY PKWY",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756052948",
            "telephone_number": "903-758-3444",
            "fax_number": "903-758-1967"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST TEXAS ORAL & MAXILLOFACIAL SURGERY ASSOCIATES INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-08",
        "last_updated": "2012-03-20",
        "status": "A",
        "authorized_official_last_name": "WILKS",
        "authorized_official_first_name": "CHARLOTTE",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "903-758-3444"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TX",
            "license": "10700",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "111312801",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "111312802",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• East Texas Gastroenterology Associates, P a
• East Texas Happy Feet Foot Clinic PC
• East Texas Kidney Specialists,PA (East Texas Kidney Specialists)
• East Texas Medical Specialists PLLC
• East Texas Minimally Inva Micro NS
• East Texas Performance Rehabilitation Inc
• East Texas PHC, LLC (Premier HomeCare)
• East Texas Plastic Surgery LLP
• East Texas Primary Care Physicians, PLLC (Primary Care Associates)
• East Texas Prosthetic-Orthotic Care

• Oral and Maxillofacial Surgery (Dentist) in Longview, TX
• Providers in Longview, 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 Mar 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.