Provider Demographics
NPI:1942685276
Name:BRAZOS ORAL & MAXILLOFACIAL SURGERY, PLLC
Entity Type:Organization
Organization Name:BRAZOS ORAL & MAXILLOFACIAL SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER/ORAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WILLIS
Authorized Official - Last Name:PLEDGER
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-394-2933
Mailing Address - Street 1:10605 SPRING GREEN BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-4048
Mailing Address - Country:US
Mailing Address - Phone:281-394-2933
Mailing Address - Fax:281-715-4440
Practice Address - Street 1:10605 SPRING GREEN BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-4048
Practice Address - Country:US
Practice Address - Phone:281-394-2933
Practice Address - Fax:281-715-4440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX238591223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty