Provider Demographics
NPI:1437565934
Name:TEXAS MAXILLOFACIAL SURGERY, PLLC
Entity Type:Organization
Organization Name:TEXAS MAXILLOFACIAL SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL AND MAXILLOFACIAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:MAZEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DURAINI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:817-431-9566
Mailing Address - Street 1:1850 KELLER PKWY
Mailing Address - Street 2:SUITE #102
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-3706
Mailing Address - Country:US
Mailing Address - Phone:817-431-9566
Mailing Address - Fax:817-337-8687
Practice Address - Street 1:1850 KELLER PKWY
Practice Address - Street 2:SUITE #102
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-3706
Practice Address - Country:US
Practice Address - Phone:817-431-9566
Practice Address - Fax:817-337-8687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-03
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery