# THE CENTER FOR ORAL, FACIAL, AND IMPLANT SURGERY PA

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

## Provider details

- **NPI number:** 1467694208
- **Authorized official:** MICHAEL DERAE SHEPPARD OMS (PRESIDENT)
- **Authorized official phone:** (817) 477-0922

## Contact information

- **Practice address:** 2310 HIGHWAY 157 N, SUITE 103, MANSFIELD, TX 76063-8844
- **Practice address phone:** (817) 477-0922
- **Practice address fax:** (817) 477-0910
- **Mailing address:** 2310 HIGHWAY 157 N, SUITE 103, MANSFIELD, TX 76063-8844
- **Mailing address phone:** (817) 477-0922
- **Mailing address fax:** (817) 477-0910

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 21182 | TX | Yes |

## Other

- **Enumeration date:** 03/25/2009
- **Last updated:** 03/25/2009