# EL PASO ORAL & FACIAL SURGEONS, PLLC

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

## Provider details

- **NPI number:** 1326423468
- **Authorized official:** MR. CLARK A. PETERSEN JR. (BUSINESS MANAGER)
- **Authorized official phone:** (618) 402-6622

## Contact information

- **Practice address:** 1390 GEORGE DIETER DR, SUITE 120, EL PASO, TX 79936-7420
- **Practice address phone:** (618) 402-6622
- **Mailing address:** 4447 N CENTRAL EXPY, SUITE 110, PMB 434, DALLAS, TX 75205-4245
- **Mailing address phone:** (618) 402-6622

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 30862 | TX | Yes |

## Other

- **Enumeration date:** 07/29/2015
- **Last updated:** 07/29/2015