Provider Demographics
NPI:1558770214
Name:CAPROCK ORAL SURGERY, PLLC
Entity Type:Organization
Organization Name:CAPROCK ORAL SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMSEY
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:FANOUS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:806-794-0001
Mailing Address - Street 1:5730 66TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-1224
Mailing Address - Country:US
Mailing Address - Phone:806-794-0001
Mailing Address - Fax:806-794-0025
Practice Address - Street 1:5730 66TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-1224
Practice Address - Country:US
Practice Address - Phone:806-794-0001
Practice Address - Fax:806-794-0025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX163431223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty