Provider Demographics
NPI:1356739528
Name:GARLAND ORAL SURGERY & DENTAL IMPLANT CENTER, P.A.
Entity type:Organization
Organization Name:GARLAND ORAL SURGERY & DENTAL IMPLANT CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:214-528-5500
Mailing Address - Street 1:2910 BROADWAY BLVD
Mailing Address - Street 2:STE. 201
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75041-3764
Mailing Address - Country:US
Mailing Address - Phone:972-271-6528
Mailing Address - Fax:972-271-6529
Practice Address - Street 1:2910 BROADWAY BLVD
Practice Address - Street 2:STE. 201
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75041-3764
Practice Address - Country:US
Practice Address - Phone:972-271-6528
Practice Address - Fax:972-271-6529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-22
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19017261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental