Provider Demographics
NPI:1932408234
Name:DENTON COUNTY ORAL AND MAXILLOFACIAL SURGERY
Entity Type:Organization
Organization Name:DENTON COUNTY ORAL AND MAXILLOFACIAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMIT
Authorized Official - Middle Name:
Authorized Official - Last Name:DHAMEJA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:940-382-4000
Mailing Address - Street 1:3307 UNICORN LAKE BLVD
Mailing Address - Street 2:STE 191
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210
Mailing Address - Country:US
Mailing Address - Phone:940-382-4000
Mailing Address - Fax:940-382-4001
Practice Address - Street 1:3307 UNICORN LAKE BLVD
Practice Address - Street 2:STE 191
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210
Practice Address - Country:US
Practice Address - Phone:940-382-4000
Practice Address - Fax:940-382-4001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-25
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX258911223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty