Provider Demographics
NPI:1013161991
Name:ORAL SURGERY PARTNERS
Entity Type:Organization
Organization Name:ORAL SURGERY PARTNERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-484-0220
Mailing Address - Street 1:12600 N FEATHERWOOD DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77034-4443
Mailing Address - Country:US
Mailing Address - Phone:281-484-0220
Mailing Address - Fax:281-484-7695
Practice Address - Street 1:12600 N FEATHERWOOD DR
Practice Address - Street 2:SUITE 220
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77034-4443
Practice Address - Country:US
Practice Address - Phone:281-484-0220
Practice Address - Fax:281-484-7695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-05
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX96831223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT14173Medicare UPIN