Provider Demographics
NPI:1669416475
Name:CORPUS CHRISTI ORAL AND MAXILLOFACIAL SURGEONS PC
Entity type:Organization
Organization Name:CORPUS CHRISTI ORAL AND MAXILLOFACIAL SURGEONS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE CLERK
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDRICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-993-2290
Mailing Address - Street 1:5756 S STAPLES ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-3796
Mailing Address - Country:US
Mailing Address - Phone:361-993-2290
Mailing Address - Fax:361-992-4961
Practice Address - Street 1:5756 S STAPLES ST F
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-3796
Practice Address - Country:US
Practice Address - Phone:361-993-2290
Practice Address - Fax:361-992-4961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0811788-01Medicaid
TXG60013-1OtherDELTA TX CHIPS
TX0098105-01Medicaid
TX0098105-01Medicaid