Provider Demographics
NPI:1790898179
Name:ORAL SURGERY ASSOCIATES OF NORTH TEXAS, PC
Entity Type:Organization
Organization Name:ORAL SURGERY ASSOCIATES OF NORTH TEXAS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-447-6685
Mailing Address - Street 1:618 N HIGHWAY 67
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-2139
Mailing Address - Country:US
Mailing Address - Phone:972-291-0297
Mailing Address - Fax:972-291-8260
Practice Address - Street 1:618 N HIGHWAY 67
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-2139
Practice Address - Country:US
Practice Address - Phone:972-291-0297
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0082927701Medicaid
TX0082927701Medicaid