# ORAL & MAXILLOFACIAL NETWORK, P.L.L.C.

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

## Provider details

- **NPI number:** 1417170655
- **Authorized official:** HOLLY MARIE PORTWOOD (CHIEF OPERATING OFFICER)
- **Authorized official phone:** (817) 920-6936

## Contact information

- **Practice address:** 1500 S MAIN ST, FORT WORTH, TX 76104-4917
- **Practice address phone:** (817) 920-6936
- **Practice address fax:** (817) 702-1035
- **Mailing address:** 1500 S MAIN ST, FORT WORTH, TX 76104-4917
- **Mailing address phone:** (817) 920-6936
- **Mailing address fax:** (817) 927-1497

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0106X | Oral and Maxillofacial Pathology Dentistry | — | NULL | — |
| 1223P0106X | Oral and Maxillofacial Pathology Dentistry | — | — | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 04/10/2007
- **Last updated:** 07/08/2024