Provider Demographics
NPI:1679671135
Name:ORAL & MAXILLOFACIAL SURGEONS OF HOUSTON
Entity Type:Organization
Organization Name:ORAL & MAXILLOFACIAL SURGEONS OF HOUSTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:STOBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-464-2833
Mailing Address - Street 1:8800 KATY FWY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-1633
Mailing Address - Country:US
Mailing Address - Phone:713-464-2833
Mailing Address - Fax:713-464-7563
Practice Address - Street 1:8800 KATY FWY
Practice Address - Street 2:SUITE 210
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-1633
Practice Address - Country:US
Practice Address - Phone:713-464-2833
Practice Address - Fax:713-464-7563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX93891223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty