Provider Demographics
NPI:1285817379
Name:TODD J. SVANE, DDS, MSD & STEVEN F. KOLB, DDS, MSD, PLLC
Entity Type:Organization
Organization Name:TODD J. SVANE, DDS, MSD & STEVEN F. KOLB, DDS, MSD, PLLC
Other - Org Name:ORAL SURGERY CENTER OF TEXOMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SVANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-868-1370
Mailing Address - Street 1:2903 HERITAGE PKWY
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-3424
Mailing Address - Country:US
Mailing Address - Phone:903-868-1370
Mailing Address - Fax:
Practice Address - Street 1:2903 HERITAGE PKWY
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-3424
Practice Address - Country:US
Practice Address - Phone:903-868-1370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14253204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0798639-01Medicaid
TX0798639-01Medicaid