# WICHITA FALLS ORAL AND FACIAL SURGERY, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Texoma Facial and Oral Surgery
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255710752
- **Authorized official:** MR. CLARK ALLEN PETERSEN JR. (OPERATIONS DIRECTOR)
- **Authorized official phone:** (618) 402-6622

## Contact information

- **Practice address:** 2304 MIDWESTERN PKWY, SUITE 102, WICHITA FALLS, TX 76308-2342
- **Practice address phone:** (940) 696-1544
- **Mailing address:** 4447 N CENTRAL EXPY, SUITE 110, PMB 434, DALLAS, TX 75205-4245
- **Mailing address phone:** (800) 215-6530

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 24871 | TX | Yes |

## Other

- **Enumeration date:** 05/29/2015
- **Last updated:** 05/29/2015