OrganizationActive
Oral & Maxillofacial Surgery of Tyler, PC
NPI 1154493922 · Oral and Maxillofacial Surgery (Dentist) · Tyler, TX
Provider details
- NPI number
- 1154493922
- Entity type
- Organization
- Primary specialty
- Oral and Maxillofacial Surgery (Dentist)Dental Providers
- Organization subpart
- No
- Authorized official
- Jerri Grace, Office Manager(903) 595-5186
- License
- 10456 & 17107 (TX)
Specialties & taxonomies
Dental Providers
Profile Score
Detailed profile(90/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
700 Olympic Plaza Cir Ste 412
Tyler, TX 75701-1952
Phone: (903) 595-5186
Fax: (903) 595-5240
Street-level locationGet directions
Mailing address
700 Olympic Plaza Cir Ste 412
Tyler, TX 75701-1952
Other names (DBA / former)
- Former legal business name
- Olympic Plaza Oral & Maxillofacial Surgery Assoc.
Registry dates
- Enumerated
- 2006-11-15
- Last updated
- 2008-07-16
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.