Provider Demographics
NPI:1649857962
Name:SPRING ORAL SURGERY & DENTAL IMPLANT CENTER
Entity type:Organization
Organization Name:SPRING ORAL SURGERY & DENTAL IMPLANT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRANZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-256-8400
Mailing Address - Street 1:26321 NORTHWEST FWY STE 700
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-5759
Mailing Address - Country:US
Mailing Address - Phone:281-256-8400
Mailing Address - Fax:281-256-8412
Practice Address - Street 1:3466 DISCOVERY CREEK BLVD STE 250
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-7130
Practice Address - Country:US
Practice Address - Phone:281-801-7866
Practice Address - Fax:281-801-7867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-24
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty