Provider Demographics
NPI:1639341241
Name:OSWALT, JERRY CHRIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:CHRIS
Last Name:OSWALT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:553 E MADISON ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:MS
Mailing Address - Zip Code:38851-2410
Mailing Address - Country:US
Mailing Address - Phone:662-456-2492
Mailing Address - Fax:
Practice Address - Street 1:553 E MADISON ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:MS
Practice Address - Zip Code:38851-2410
Practice Address - Country:US
Practice Address - Phone:662-456-2492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2093-841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice