Provider Demographics
NPI:1184091340
Name:I-20 ORAL SURGERY PLLC
Entity type:Organization
Organization Name:I-20 ORAL SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JED
Authorized Official - Middle Name:
Authorized Official - Last Name:HILDEBRAND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:817-468-4141
Mailing Address - Street 1:2200 W I 20
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-1648
Mailing Address - Country:US
Mailing Address - Phone:817-962-2318
Mailing Address - Fax:817-468-7779
Practice Address - Street 1:2200 W I 20
Practice Address - Street 2:SUITE 300
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-1648
Practice Address - Country:US
Practice Address - Phone:817-962-2318
Practice Address - Fax:817-468-7779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty