# CLEBURNE ORAL SURGERY PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043023088
- **Authorized official:** DR. DAVID WAYNE KOSTOHRYZ JR. DDS, MD (OWNER)
- **Authorized official phone:** (817) 357-8999

## Contact information

- **Practice address:** 2010 W KATHERINE P RAINES RD STE 700, CLEBURNE, TX 76033-7462
- **Practice address phone:** (817) 357-8999
- **Practice address fax:** (817) 357-8998
- **Mailing address:** 2010 W KATHERINE P RAINES RD STE 700, CLEBURNE, TX 76033-7462
- **Mailing address phone:** (817) 357-8999

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 01/31/2025
- **Last updated:** 01/31/2025