Provider Demographics
NPI:1578674446
Name:ORAL SURGERY ASSOCIATES INC
Entity Type:Organization
Organization Name:ORAL SURGERY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:REX
Authorized Official - Last Name:EATMON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-243-5035
Mailing Address - Street 1:10 MEDICAL PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234
Mailing Address - Country:US
Mailing Address - Phone:972-243-5035
Mailing Address - Fax:972-243-8574
Practice Address - Street 1:10 MEDICAL PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234
Practice Address - Country:US
Practice Address - Phone:972-243-5035
Practice Address - Fax:972-243-8574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX088751223S0112X
CO1901223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00R838Medicare ID - Type Unspecified
T13118Medicare UPIN