Provider Demographics
NPI:1689133191
Name:DENTON ORTHO-SURGICAL SERVICES PLLC
Entity Type:Organization
Organization Name:DENTON ORTHO-SURGICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:J. MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHILE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-774-5004
Mailing Address - Street 1:PO BOX 8308
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77387-8308
Mailing Address - Country:US
Mailing Address - Phone:281-820-1900
Mailing Address - Fax:
Practice Address - Street 1:220 N RIDGEWAY DR
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-4115
Practice Address - Country:US
Practice Address - Phone:817-774-5004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-14
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty