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Organization
EL PASO ORAL & FACIAL SURGEONS, PLLC
Active
Organization
EL PASO ORAL & FACIAL SURGEONS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CLARK A. PETERSEN JR. (BUSINESS MANAGER)
(618) 402-6622
Entity
Organization
Contact information
Practice address
1390 GEORGE DIETER DR, SUITE 120, EL PASO, TX 79936-7420
(618) 402-6622
Mailing address
4447 N CENTRAL EXPY, SUITE 110, PMB 434, DALLAS, TX 75205-4245
(618) 402-6622
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
30862
TX
Other
Enumeration date
07/29/2015
Last updated
07/29/2015
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