Provider Demographics
NPI:1700017688
Name:SAN ANTONIO ORAL & MAXILLOFACIAL SURGERY ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:SAN ANTONIO ORAL & MAXILLOFACIAL SURGERY ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:B
Authorized Official - Last Name:MAZOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:830-538-9800
Mailing Address - Street 1:1014 PARIS ST STE A
Mailing Address - Street 2:
Mailing Address - City:CASTROVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78009-2956
Mailing Address - Country:US
Mailing Address - Phone:830-538-9800
Mailing Address - Fax:830-538-9801
Practice Address - Street 1:1014 PARIS ST STE A
Practice Address - Street 2:
Practice Address - City:CASTROVILLE
Practice Address - State:TX
Practice Address - Zip Code:78009-2956
Practice Address - Country:US
Practice Address - Phone:830-538-9800
Practice Address - Fax:830-538-9801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-27
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty