Provider Demographics
NPI:1003014416
Name:SOUTHWEST CENTER FOR ORAL AND MAXILLOFACIAL SURGERY
Entity Type:Organization
Organization Name:SOUTHWEST CENTER FOR ORAL AND MAXILLOFACIAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LITZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-933-9950
Mailing Address - Street 1:5819 HIGHWAY 6
Mailing Address - Street 2:SUITE #350
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-4052
Mailing Address - Country:US
Mailing Address - Phone:281-933-9950
Mailing Address - Fax:281-933-9953
Practice Address - Street 1:5819 HIGHWAY 6
Practice Address - Street 2:SUITE #350
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-4052
Practice Address - Country:US
Practice Address - Phone:281-933-9950
Practice Address - Fax:281-933-9953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00961WMedicare PIN