Lafayette Oral and Maxillofacial Surgery Group, P.C.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

1201055A Issued in IN

Legal business name

LAFAYETTE ORAL AND MAXILLOFACIAL SURGERY GROUP, P.C.

Practice address

2 Executive Dr
Suite a
Lafayette, IN 47905-4859

Phone

(765) 807-0230

Fax

(765) 807-0234

NPI assigned

Oct 19, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Brett Anthony Henrikson, D.D.S

Title

President

Phone

(765) 807-0230

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• William Anthony Hughes, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Crawfordsville, IN
  • NPI 1134387806
  NPD (past)

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1972685238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 EXECUTIVE DR",
            "address_2": "SUITE A",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479054859",
            "telephone_number": "765-807-0230",
            "fax_number": "765-807-0234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 EXECUTIVE DR",
            "address_2": "SUITE A",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479054859",
            "telephone_number": "765-807-0230",
            "fax_number": "765-807-0234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAFAYETTE ORAL AND MAXILLOFACIAL SURGERY GROUP, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HENRIKSON",
        "authorized_official_first_name": "BRETT",
        "authorized_official_middle_name": "ANTHONY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "765-807-0230",
        "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": "IN",
            "license": "1201055A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BC/BS",
            "identifier": "600000340871",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Lafayette Integrative Health Center
• Lafayette Neonatal Associates PC
• Lafayette Otolaryngology Associates, Inc (Lafayette ENT)
• Lafayette Pain Care, P.C.
• Lafayette Pediatric Dentistry & Orthodontics
• Lafayette Podiatry Associates, P.C.
• Lafayette Radiology LLC

• Oral and Maxillofacial Surgery (Dentist) in Lafayette, IN
• Providers in Lafayette, IN by specialty
• Oral and Maxillofacial Surgery (Dentist) in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.