Provider Demographics
NPI:1467709865
Name:SUMMERWOOD ORAL & MAXILLOFACIAL SURGERY
Entity Type:Organization
Organization Name:SUMMERWOOD ORAL & MAXILLOFACIAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:BACHOURA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MD
Authorized Official - Phone:713-817-4557
Mailing Address - Street 1:26321 NORTHWEST FREEWAY
Mailing Address - Street 2:STE. 700
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429
Mailing Address - Country:US
Mailing Address - Phone:832-689-6311
Mailing Address - Fax:
Practice Address - Street 1:13141 W LAKE HOUSTON PKWY
Practice Address - Street 2:STE. 700
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77044
Practice Address - Country:US
Practice Address - Phone:281-256-8400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-06
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty