Provider Demographics
NPI:1821496423
Name:PLATINUM FACIAL SURGICAL GROUP
Entity Type:Organization
Organization Name:PLATINUM FACIAL SURGICAL GROUP
Other - Org Name:WOODLANDS ORAL AND FACIAL SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ ORAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:J.
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:TABARINI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MS
Authorized Official - Phone:281-419-3223
Mailing Address - Street 1:10857 KUYKENDAHL RD STE 150
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77382-2777
Mailing Address - Country:US
Mailing Address - Phone:281-419-3223
Mailing Address - Fax:713-436-0892
Practice Address - Street 1:10857 KUYKENDAHL RD STE 150
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77382-2777
Practice Address - Country:US
Practice Address - Phone:281-419-3223
Practice Address - Fax:713-436-0892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-12
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX237941223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty