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LAKE JACKSON ORAL AND MAXILLOFACIAL SURGERY, PLLC
NPI 1831557370
Dentist - Oral and Maxillofacial Surgery in Lake Jackson, TX

Active since January 28, 2016
103 ABNER JACKSON PKWY, LAKE JACKSON, TX 77566(979) 299-6878(979) 299-6166 Get Directions Write a Review

NPPES record last updated: January 28, 2016. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Lake Jackson Oral And Maxillofacial Surgery, Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LAKE JACKSON ORAL AND MAXILLOFACIAL SURGERY, PLLC (NPI 1831557370) is a healthcare organization registered as an oral and maxillofacial surgery in Lake Jackson, Texas and active in the NPI registry since January 2016. The organization lists Nathan Phillips, Provider, as its authorized official.

NPPES Registry Identity

NPI1831557370
Entity TypeOrganization
Primary Taxonomy1223S0112X
Legal Business NameLAKE JACKSON ORAL AND MAXILLOFACIAL SURGERY, PLLC
Location Address103 ABNER JACKSON PKWYLake Jackson, TX 77566-5163
Mailing Address103 Abner Jackson PkwyLake Jackson, TX 77566-5163 · (979) 299-6878 · Fax (979) 299-6166
Phone(979) 299-6878
Fax(979) 299-6166
Organization SubpartNo
Authorized OfficialNathan PhillipsProvider · (979) 299-6878
Enumeration DateJanuary 28, 2016
✔ NPI 1831557370 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Oral and Maxillofacial SurgeryDental Providers
Taxonomy Code1223S0112X
License✔ Licensed in TX · 16829
Definition
An oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.
103 ABNER JACKSON PKWY, Lake Jackson, TX 77566
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Other Identifiers 1

Medicaid3377855TX

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

RICHARD C FUGLER DDS , MD
Dentist (Oral and Maxillofacial Surgery)
103 ABNER JACKSON PKWY, STE A
LAKE JACKSON, TX 77566
Brazoria County (979) 299-6878
DR. GINGER BATTLE STAGG DDS
Dentist (Pediatric Dentistry)
103 ABNER JACKSON PKWY
LAKE JACKSON, TX 77566
Brazoria County (979) 297-5437

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Lake Jackson Oral And Maxillofacial Surgery, PLLC's NPI number?

The NPI number for Lake Jackson Oral And Maxillofacial Surgery, PLLC is 1831557370. It was assigned to this organization in the NPPES registry on January 28, 2016.

Where is Lake Jackson Oral And Maxillofacial Surgery, PLLC located?

Lake Jackson Oral And Maxillofacial Surgery, PLLC is located at 103 Abner Jackson Pkwy, Lake Jackson, TX 77566. The listed phone number is (979) 299-6878.

What is Lake Jackson Oral And Maxillofacial Surgery, PLLC's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Surgery, with taxonomy code 1223S0112X.

When was this NPI record last updated?

The NPPES record for Lake Jackson Oral And Maxillofacial Surgery, PLLC was last updated on January 28, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.