Provider Demographics
NPI:1710249479
Name:NORTH TEXAS CENTER FOR ORAL AND MAXILLOFACIAL SURGERY
Entity Type:Organization
Organization Name:NORTH TEXAS CENTER FOR ORAL AND MAXILLOFACIAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:SOHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DMD
Authorized Official - Phone:817-490-9979
Mailing Address - Street 1:2800 STATE HWY 114
Mailing Address - Street 2:SUITE 340
Mailing Address - City:TROPHY CLUB
Mailing Address - State:TX
Mailing Address - Zip Code:76262
Mailing Address - Country:US
Mailing Address - Phone:817-490-9979
Mailing Address - Fax:817-490-1442
Practice Address - Street 1:2800 STATE HIGHWAY 114
Practice Address - Street 2:SUITE 340
Practice Address - City:TROPHY CLUB
Practice Address - State:TX
Practice Address - Zip Code:76262
Practice Address - Country:US
Practice Address - Phone:817-490-9979
Practice Address - Fax:817-490-1442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty