Provider Demographics
NPI:1043544893
Name:ORAL AND MAXILLOFACIAL SURGERY OF SOUTH TEXAS, P.A.
Entity Type:Organization
Organization Name:ORAL AND MAXILLOFACIAL SURGERY OF SOUTH TEXAS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:M
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MSD
Authorized Official - Phone:956-878-1222
Mailing Address - Street 1:4728 S. JACKSON ROAD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-6199
Mailing Address - Country:US
Mailing Address - Phone:956-878-1222
Mailing Address - Fax:956-878-1228
Practice Address - Street 1:4728 SOUTH JACKSON RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539
Practice Address - Country:US
Practice Address - Phone:956-878-1222
Practice Address - Fax:956-878-1228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-28
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201371223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX210859903OtherTRADITIONAL MEDICAID
TX210859901OtherTHSTEPS DENTAL MEDICAID
TX210859905OtherCSHCN MEDICAL MEDICAID
TX210859902OtherCSHCN DENTAL MEDICAID
TX210859904OtherTHSTEPS MEDICAL MEDICAID
TX210859903OtherTRADITIONAL MEDICAID