# CITRUS ORAL AND MAXILLOFACIAL SURGERY PA

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

## Provider details

- **NPI number:** 1447528906
- **Authorized official:** DR. ROBERT L BROCKETT DMD (OWNER/PRESIDENT)
- **Authorized official phone:** (352) 795-4994

## Contact information

- **Practice address:** 6129 W CORPORATE OAKS DR, CRYSTAL RIVER, FL 34429-8732
- **Practice address phone:** (352) 795-4994
- **Mailing address:** 6129 W CORPORATE OAKS DR, CRYSTAL RIVER, FL 34429-8732
- **Mailing address phone:** (352) 795-4994

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 8810 | FL | Yes |

## Other

- **Enumeration date:** 12/12/2011
- **Last updated:** 12/12/2011