Provider Demographics
NPI:1821219866
Name:TEXAS ORAL MAXILLOFACIAL SURGERY ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:TEXAS ORAL MAXILLOFACIAL SURGERY ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MALCOLM
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-371-1222
Mailing Address - Street 1:7517 CAMERON RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-2057
Mailing Address - Country:US
Mailing Address - Phone:512-371-1222
Mailing Address - Fax:512-371-3914
Practice Address - Street 1:5656 BEE CAVE RD
Practice Address - Street 2:SUITE C102
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-5280
Practice Address - Country:US
Practice Address - Phone:512-327-9933
Practice Address - Fax:512-327-9944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX151921223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty