Provider Demographics
NPI:1700966462
Name:DENTON ORAL AND MAXILLOFACIAL SURGERY ASSOCIATES
Entity Type:Organization
Organization Name:DENTON ORAL AND MAXILLOFACIAL SURGERY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:940-387-9015
Mailing Address - Street 1:1300 FULTON ST STE 402
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-2661
Mailing Address - Country:US
Mailing Address - Phone:940-387-9015
Mailing Address - Fax:940-898-1649
Practice Address - Street 1:1300 FULTON ST STE 402
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-2661
Practice Address - Country:US
Practice Address - Phone:940-387-9015
Practice Address - Fax:940-898-1649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00L07VMedicare ID - Type Unspecified