Provider Demographics
NPI:1942691597
Name:ORAL AND FACIAL SURGERY OF NORTH TEXAS
Entity Type:Organization
Organization Name:ORAL AND FACIAL SURGERY OF NORTH TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-434-0050
Mailing Address - Street 1:591 W MAIN ST # 150
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-3628
Mailing Address - Country:US
Mailing Address - Phone:972-434-0050
Mailing Address - Fax:972-434-0095
Practice Address - Street 1:591 W MAIN ST # 150
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-3628
Practice Address - Country:US
Practice Address - Phone:972-434-0050
Practice Address - Fax:972-434-0095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-17
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207531223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty