Provider Demographics
NPI:1477540052
Name:TEXAS ORAL AND FACIAL SURGERY
Entity Type:Organization
Organization Name:TEXAS ORAL AND FACIAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:L
Authorized Official - Last Name:WIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:281-395-1200
Mailing Address - Street 1:810 S MASON RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-3895
Mailing Address - Country:US
Mailing Address - Phone:281-395-1200
Mailing Address - Fax:281-395-1201
Practice Address - Street 1:810 S MASON RD
Practice Address - Street 2:SUITE 301
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-3895
Practice Address - Country:US
Practice Address - Phone:281-395-1200
Practice Address - Fax:281-395-1201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX189861223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX88D134OtherBC/BS PROVIDER
TX164989OtherDBP
TX51107OtherASSURANCE
TX509663782OtherUCCI
TX51107OtherDHA