Provider Demographics
NPI:1518389212
Name:DFW ORAL AND MAXILLOFACIAL SURGERY ENNIS, LLC
Entity Type:Organization
Organization Name:DFW ORAL AND MAXILLOFACIAL SURGERY ENNIS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:F
Authorized Official - Last Name:FRANCO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-594-7414
Mailing Address - Street 1:2727 N. O'CONNOR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062
Mailing Address - Country:US
Mailing Address - Phone:972-594-7414
Mailing Address - Fax:972-594-1834
Practice Address - Street 1:2200 W ENNIS AVE
Practice Address - Street 2:STE. B
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119-8054
Practice Address - Country:US
Practice Address - Phone:972-875-7616
Practice Address - Fax:972-875-7618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-15
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN208161223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty