Provider Demographics
NPI:1437397148
Name:ORAL & MAXILLOFACIAL SURGERY AFFILIATES, P.C.
Entity Type:Organization
Organization Name:ORAL & MAXILLOFACIAL SURGERY AFFILIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:PRITCHARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:254-751-1171
Mailing Address - Street 1:7030 SANGER AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712
Mailing Address - Country:US
Mailing Address - Phone:254-751-1171
Mailing Address - Fax:254-751-0884
Practice Address - Street 1:7030 SANGER AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712
Practice Address - Country:US
Practice Address - Phone:254-751-1171
Practice Address - Fax:254-751-0884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-03
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10880261QS0112X
TXT15373261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery