Provider Demographics
NPI:1114018124
Name:CENTRAL TEXAS ORAL SURGERY ASSC.
Entity Type:Organization
Organization Name:CENTRAL TEXAS ORAL SURGERY ASSC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:FRANKLIN
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:BONASSO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-320-1640
Mailing Address - Street 1:3200 RED RIVER
Mailing Address - Street 2:#400
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705
Mailing Address - Country:US
Mailing Address - Phone:512-320-1640
Mailing Address - Fax:512-320-1643
Practice Address - Street 1:3200 RED RIVER
Practice Address - Street 2:#400
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705
Practice Address - Country:US
Practice Address - Phone:512-320-1640
Practice Address - Fax:512-320-1643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX185151223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0015705OtherASSURANT
TXD18515OtherBLUE CROSS BLUE SHIELD