Provider Demographics
NPI:1629067657
Name:RECONSTRUCTIVE ORAL AND MAXILLOFACIAL SURGERY PA
Entity Type:Organization
Organization Name:RECONSTRUCTIVE ORAL AND MAXILLOFACIAL SURGERY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR CO OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:M
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD MSD
Authorized Official - Phone:956-664-1695
Mailing Address - Street 1:2601 W TRENTON RD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-3432
Mailing Address - Country:US
Mailing Address - Phone:956-664-1695
Mailing Address - Fax:956-664-1798
Practice Address - Street 1:2601 W TRENTON RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-3432
Practice Address - Country:US
Practice Address - Phone:956-664-1695
Practice Address - Fax:956-664-1798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164024502Medicaid
TX164024501Medicaid
TX00687TMedicare PIN