Provider Demographics
NPI:1912592692
Name:ORAL SURGERY OF TEXAS PLLC
Entity Type:Organization
Organization Name:ORAL SURGERY OF TEXAS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ONBOARDING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:PERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-692-1000
Mailing Address - Street 1:505 E HUNTLAND DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-3717
Mailing Address - Country:US
Mailing Address - Phone:512-276-4444
Mailing Address - Fax:
Practice Address - Street 1:1015 W 34TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-2008
Practice Address - Country:US
Practice Address - Phone:512-206-2929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty