Provider Demographics
NPI:1255855839
Name:MEMORIAL ORAL AND MAXILLOFACIAL SURGERY OF KATY/FULSHEAR
Entity Type:Organization
Organization Name:MEMORIAL ORAL AND MAXILLOFACIAL SURGERY OF KATY/FULSHEAR
Other - Org Name:BRAZOS ORAL AND MAXILLOFACIAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RODOLFO
Authorized Official - Middle Name:
Authorized Official - Last Name:GARZA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:281-394-2933
Mailing Address - Street 1:10605 SPRING GREEN BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-3595
Mailing Address - Country:US
Mailing Address - Phone:281-394-2933
Mailing Address - Fax:281-715-4440
Practice Address - Street 1:10605 SPRING GREEN BLVD STE 200
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-3595
Practice Address - Country:US
Practice Address - Phone:281-394-2933
Practice Address - Fax:281-715-4440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27084204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty