# KERRVILLE ORAL & MAXILLOFACIAL SURGERY, P.A.

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

## Provider details

- **NPI number:** 1427341502
- **Authorized official:** DR. RYAN GREEN (PRESIDENT)
- **Authorized official phone:** (903) 526-7366

## Contact information

- **Practice address:** 501 JEFFERSON ST, SUITE 2, KERRVILLE, TX 78028-4561
- **Practice address phone:** (830) 895-3494
- **Practice address fax:** (830) 896-3390
- **Mailing address:** 501 JEFFERSON ST, SUITE 2, KERRVILLE, TX 78028-4561
- **Mailing address phone:** (830) 895-3494
- **Mailing address fax:** (830) 896-3390

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 24237 | TX | Yes |

## Other

- **Enumeration date:** 05/23/2011
- **Last updated:** 07/08/2011