Provider Demographics
NPI:1942482807
Name:SAN GABRIEL ORAL & MAXILLOFACIAL SURGERY ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:SAN GABRIEL ORAL & MAXILLOFACIAL SURGERY ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAELANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:512-868-2233
Mailing Address - Street 1:701 SAN GABRIEL VILLAGE BLVD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-5594
Mailing Address - Country:US
Mailing Address - Phone:512-868-2233
Mailing Address - Fax:512-868-2210
Practice Address - Street 1:701 SAN GABRIEL VILLAGE BLVD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-5594
Practice Address - Country:US
Practice Address - Phone:512-868-2233
Practice Address - Fax:512-868-2210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX209651223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty