Provider Demographics
NPI:1497078539
Name:TEXAS ORAL SURGERY GROUP, LLP
Entity Type:Organization
Organization Name:TEXAS ORAL SURGERY GROUP, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KARI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-596-9242
Mailing Address - Street 1:3713 W 15TH ST
Mailing Address - Street 2:SUITE 403
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-7754
Mailing Address - Country:US
Mailing Address - Phone:972-596-9242
Mailing Address - Fax:972-612-0787
Practice Address - Street 1:3713 W 15TH ST
Practice Address - Street 2:SUITE 403
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-7754
Practice Address - Country:US
Practice Address - Phone:972-596-9242
Practice Address - Fax:972-612-0787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX163431223S0112X
TX118601223S0112X
TX115211223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty