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Organization
ORAL & MAXILLOFACIAL NETWORK, P.L.L.C.
Active
Organization
ORAL & MAXILLOFACIAL NETWORK, P.L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HOLLY MARIE PORTWOOD (CHIEF OPERATING OFFICER)
(817) 920-6936
Entity
Organization
Contact information
Practice address
1500 S MAIN ST, FORT WORTH, TX 76104-4917
(817) 920-6936
(817) 702-1035
Mailing address
1500 S MAIN ST, FORT WORTH, TX 76104-4917
(817) 920-6936
(817) 927-1497
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
—
NULL
1223P0106X
Oral and Maxillofacial Pathology Dentistry
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
NULL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
04/10/2007
Last updated
07/08/2024
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