Provider Demographics
NPI:1407986128
Name:SAN ANTONIO ORAL AND MAXILLOFACIAL SURGERY ASSOCIATES, P,A.
Entity Type:Organization
Organization Name:SAN ANTONIO ORAL AND MAXILLOFACIAL SURGERY ASSOCIATES, P,A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:B
Authorized Official - Last Name:MAZOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-696-7500
Mailing Address - Street 1:5282 MEDICAL DR STE 316
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-6044
Mailing Address - Country:US
Mailing Address - Phone:210-696-7500
Mailing Address - Fax:
Practice Address - Street 1:5282 MEDICAL DR STE 316
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-6044
Practice Address - Country:US
Practice Address - Phone:210-696-7500
Practice Address - Fax:210-692-0248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty