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Organization
THE CENTER FOR ORAL, FACIAL, AND IMPLANT SURGERY PA
Active
Organization
THE CENTER FOR ORAL, FACIAL, AND IMPLANT SURGERY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL DERAE SHEPPARD OMS (PRESIDENT)
(817) 477-0922
Entity
Organization
Contact information
Practice address
2310 HIGHWAY 157 N, SUITE 103, MANSFIELD, TX 76063-8844
(817) 477-0922
(817) 477-0910
Mailing address
2310 HIGHWAY 157 N, SUITE 103, MANSFIELD, TX 76063-8844
(817) 477-0922
(817) 477-0910
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
21182
TX
Other
Enumeration date
03/25/2009
Last updated
03/25/2009
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