Simon Lucas Mack, D.D.S.
NPI 1639676166ActiveIndividual· Dentist· Longview, TX
Dentist (D.D.S.) with East Texas Oral and Maxillofacial Surgery Associates Inc, practicing in Longview, Texas. 20 Medicare patients in 2024, $4,615 paid; all of their 574 Part D prescriptions were generic.
Overview
| NPI | 1639676166 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | D.D.S. |
| Sole proprietor | No |
| NPI issued | Apr 11, 2018 |
| Last updated in NPPES | Sep 9, 2022 |
| Certified by provider | Sep 9, 2022 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Dentist Primary | 122300000X | 34781 | TX |
| Student in an Organized Health Care Education/Training Program | 390200000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Dentist (TX) |
|---|---|
| Accepts assignment | Yes (participating) |
Medicare services in 2024
| Medicare patients | 20 |
|---|---|
| Services billed | 34 across 13 procedure codes |
| Paid by Medicare | $4,615 |
Part D prescriptions in 2024
| Prescriptions (claims) | 574 · 580 30-day fills |
|---|---|
| Patients | 276 |
| Total drug cost | $3,303 |
| Generic share | 100% of claims |
Education and affiliations
| Graduation year | 2018 |
|---|---|
| Medicare specialty | Dentist |
| Secondary specialties | Oral Surgery |
Medical group
- East Texas Oral and Maxillofacial Surgery Associates IncMount Pleasant, TX · 3 clinicians
Industry payments (Open Payments)
None reported for 2025 or 2024.
Receiving payments does not imply wrongdoing. What Open Payments covers ·original records
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