Provider Demographics
NPI:1437431442
Name:MAXILLOFACIAL SURGERY SERVICES OF CENTRAL TEXAS, PLLC
Entity Type:Organization
Organization Name:MAXILLOFACIAL SURGERY SERVICES OF CENTRAL TEXAS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRINCIPAL MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:210-380-5576
Mailing Address - Street 1:10801 N MOPAC EXPY
Mailing Address - Street 2:BLDG 2 SUITE 130
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-5459
Mailing Address - Country:US
Mailing Address - Phone:512-372-6230
Mailing Address - Fax:512-372-6233
Practice Address - Street 1:10801 N MOPAC EXPY
Practice Address - Street 2:BLDG 2 SUITE 130
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-5459
Practice Address - Country:US
Practice Address - Phone:512-372-6230
Practice Address - Fax:512-372-6233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX229531223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty