Provider Demographics
NPI:1881870970
Name:ALLIANCE ORAL & MAXILLOFACIAL SURGERY, P.A.
Entity type:Organization
Organization Name:ALLIANCE ORAL & MAXILLOFACIAL SURGERY, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:PARMER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:817-741-2200
Mailing Address - Street 1:9415 N BEACH ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-9059
Mailing Address - Country:US
Mailing Address - Phone:817-741-2200
Mailing Address - Fax:817-741-2216
Practice Address - Street 1:9415 N BEACH ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-9059
Practice Address - Country:US
Practice Address - Phone:817-741-2200
Practice Address - Fax:817-741-2216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX165351223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00U05QMedicare PIN